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# Sponsor Spotlight: QI Project Increases Hepatitis C Screenings in Utah
*On July 20, 2021*
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## ABMS Portfolio Program Sponsor Spotlight: University of Utah Health
As one of the newest and smallest clinics of the University of Utah Health system, the South Ogden Health Center wanted to tackle a straightforward, measurable QI project that could have a positive impact in its community.
After considering the 19 quality measures the clinic reviews monthly, the team chose to focus on increasing the number of hepatitis C screenings in community members born between 1945 and 1965, as recommended by the CDC. Adults born within this time frame have an estimated three percent prevalence of hepatitis C virus antibodies, which is six times higher than adults born in other years. The project team set a modest goal of increasing the hepatitis C screening rate in this population from 45.4 percent to 55 percent.
“Given that having hepatitis C can lead to life-threatening health problems like cirrhosis and liver cancer, we felt it was an important target for our QI effort,” said Emily Carlson, MHA, PCMH CCE, LSSGB, the Quality Manager for the Community Physicians Group, University of Utah Health. “While there is no vaccine for hepatitis C, getting tested is important because treatments can cure most people with hepatitis C in just a few months, before they become symptomatic.”
The “Increasing Hepatitis C Screening at South Ogden Health Center” project team brainstormed intervention opportunities to improve hepatitis C screening rates in their clinic. First, the team started with a clean-up of patient data to make sure the appropriate high-risk patients were being targeted. Next, the team reimagined the patient appointment experience to insert natural opportunities to talk with patients about the importance of hepatitis C screenings. All clinic staff members, from the reception desk to the lab techs, were educated on the project, so that the entire team was using shared language when talking with patients and completing paperwork.
The project team included hepatitis C screening on the Pre-Visit Planning sheet to identify patients who need screening. Eye-catching ads and educational materials about hepatitis C and screening were created and placed in the waiting and exam rooms by the patient advisory board and Communications department. The team created magnets to place on the patient’s exam room door to identify when in-room hepatitis C screenings were needed. The team added hepatitis C screening information on the After-Visit Summary that patients receive. Before they left the office, patients were encouraged to schedule follow-ups and get labs drawn onsite. “Hepatitis C Champion” physicians were identified early on in case a patient was diagnosed with the virus and a referral needed to be made. Monthly quality meetings were held by the team to review data and discuss how to remove or work around barriers to patient getting screened.
“Due to the severity of hepatitis C and the ease of the screening test, we thought it would be relatively simple to convince patients to get tested, but we underestimated the cultural barriers we would face,” said Carlson. “We should have talked with more patients to discuss the potential cultural challenges first, to get a realistic picture of the community.”
Located just outside Salt Lake City, the community around the South Ogden Health Center has a significant population of people who are members of The Church of Jesus Christ of Latter-day Saints. Given that this group generally avoids perceived “bad” behaviors that are coincidentally known to spread hepatitis C, such as injection-drug use, getting unregulated tattoos, or having sex with an infected person, they do not feel their risk is high enough to warrant getting screened. To counter this resistance, the project team changed tactics and instead educated patients about how “innocent” activities could expose them to hepatitis C, such as sharing personal items such as razors or toothbrushes or getting a manicure or pedicure with improperly sterilized instruments.
“By teaching patients that a hepatitis C screening is not a judgment of them or their lifestyle, just a part of regular health care, we were able to reach many more people,” said Carlson. “We reassured them that if the test was negative for hepatitis C that was great, but if it was positive, then we have medicine for them and can help them right away.”
Fortunately, the cultural obstacles became easier to deal with, and the results of this project were exceptional. At its baseline, only 45 percent of patients had been screened for hepatitis in March 2019. By May 2021, that number jumped to 75.4 percent, despite the COVID-19 pandemic, when most well visits were cancelled for months. With the changes made in their processes and the community education, the project team expects that number to continue to climb.
Anecdotally, several asymptomatic cases of hepatitis C were found in the community and those patients were immediately referred to and treated by the “Hepatitis C Champion” physicians the team identified.
“The ABMS Portfolio Program has made earning continuing certification more accessible to our providers, which frees them up to take care of their patients, which is our ultimate goal,” said Sahar Pastel-Daneshgar, Maintenance of Certification (MOC) Coordinator for University of Utah Health. “By integrating the QI work providers are already doing into their continuing board certification efforts, it is a win-win-win for the patients, providers, and institution.”
Continuing certification credit for this project was granted by the , the , and the .
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# ABMS Member Boards Evolve Assessments for Specialties, Subspecialties
*On April 4, 2023*
Shifting from a secure, point-in-time examination to a more frequent innovative assessment doesn’t happen overnight. Developing, pilot testing, and implementing assessment programs takes years. To gain a scope of the project, consider that six American Board of Medical Specialties (ABMS) Member Boards have more than one primary specialty while five boards have 10 or more subspecialties. That often requires launching and implementing assessments in phases, typically starting with a specialty and moving to subspecialties. Throughout the process, the boards have solicited feedback from board certified physicians and medical specialists to ensure that these programs are meeting their needs—providing relevant content and supporting professional development—while simultaneously serving as a robust mechanism for assessing knowledge, expertise, and professionalism. The following are examples of how Member Boards have implemented their formative assessments for continuing certification in a phased-in approach that covers their specialties and subspecialties.
### Tracking implementation
The American Board of Surgery (ABS) introduced its  for specialty certification in general surgery in 2018. The following year, the board launched the program for specialty certification in vascular surgery, and in two subspecialties. In 2021, ABS implemented the assessment for its two remaining subspecialties.
Two years after the American Board of Pediatrics (ABP) started pilot testing the Maintenance of Certification Assessment for Pediatrics (), the board implemented MOCA-Peds in 2019 for primary certification in general pediatrics, and in three subspecialties. In 2020, ABP introduced MOCA-Peds in four additional subspecialties. The board rolled out the program for four more subspecialties in 2021, which is the same year that ABP received the  from the Institute for Credentialing Excellence for developing MOCA-Peds. Last year, ABP implemented MOCA-Peds for its four remaining subspecialties.
The American Board of Radiology rolled out its  (OLA) for specialty certification in diagnostic radiology in 2019. The following year, the board launched OLA for its three remaining specialties and four subspecialties.
In 2020, three months after the American Board of Physical Medicine and Rehabilitation (ABPMR) replaced its Maintenance of Certification (MOC) Exam with longitudinal assessment, now known as , the board introduced a longitudinal assessment for pain medicine. In 2024, ABPMR will introduce a longitudinal assessment for brain injury medicine. In addition, ABPMR is targeting 2025 to launch longitudinal assessments for two additional subspecialties.
After a successful three-year pilot, the American Board of Family Medicine (ABFM) launched the  (FMCLA) in 2022 as a permanent alternative to its one-day continuing certification exam. As other Member Boards have implemented longitudinal assessments, ABFM has partnered with them to expand opportunities to maintain certificate of additional qualifications using the longitudinal approach. As an example, ABFM certified physicians who currently hold Certificates of Added Qualifications in five subspecialty areas can participate in other Member Boards’ assessments.
The American Board of Emergency Medicine (ABEM) launched six  modules in 2021. One year later, it added two more modules. This year, ABEM introduced MyEMSCert for subspecialty certification in emergency medical services. Next year, ABEM will roll out MyToxCert for subspecialty certification in medical toxicology.
The American Board of Internal Medicine (ABIM) rolled out the  (LKA®) for 12 subspecialties in 2022. This year, ABIM launched the LKA in three more subspecialties and introduced a focused version of its Sleep Medicine LKA in obstructive sleep apnea. Next year, ABIM will introduce  designed for those who practice primarily in an inpatient setting.
The American Board of Psychiatry and Neurology launched its  in 2022 for its specialties and subspecialties, except for neurocritical care, which will be added in 2025.
### Making adjustments
As Member Boards continue to seek ways to best support board certified physicians and medical specialists, they are fine-tuning their formative assessments. Often, these modifications are made in direct response to the feedback the boards have received from those physicians and medical specialists.
As an example, ABPMR and the  (ABCRS), have added article-based questions to their longitudinal assessments. The feedback from physicians board certified by ABCRS has been positive with more than 95 percent indicating that the quality of the articles used for the article-based questions was appropriate. The American Board of Pathology (ABPath) recently launched a continuous quality improvement initiative that will ensure only questions of the highest quality and relevance are used in , while simultaneously introducing new, relevant material.
Earlier this year, the  created a library of the nearly 200 articles that CertLink questions have been based on since the pilot began four years ago. This allows board certified dermatologists to view the articles, which focus on key advances in the field, at their convenience.
The American Board of Obstetrics and Gynecology (ABOG) recently began mapping its  items to the specialty and subspecialty blueprints, allowing for greater analysis of performance data and identification of specialty-based knowledge gaps. ABOG will share this data with specialty and subspecialty societies so that educational programs may be developed or enhanced to address aggregate knowledge deficits.
The American Board of Plastic Surgery, which launched its  in 2019, has since implemented *clone* items within each yearly assessment. Clone items are used to identify knowledge gaps with the worst performing items, which are presented again in the subsequent assessment to promote learning.
Member Boards will continue their efforts to ensure that their innovative assessment programs support board certified physicians’ and medical specialists’ efforts to provide the best care possible for their patients.
*© 2023 American Board of Medical Specialties®*
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