Hereditary Breast Cancer Quality Improvement Pilot Project

The Family Medicine Education Consortium (FMEC) is partnering with the National Association of Chronic Disease Directors on a cancer prevention and early detection quality improvement (QI) pilot project funded by the Centers for Disease Control and Prevention (CDC).  Our geographic area works with over 200 family medicine residency training programs and 60 medical schools in the northeast region of the United States.

JANUARY 2024

HEREDITARY BREAST CANCER QUALITY IMPROVEMENT PILOT PROJECT UPDATES

The FMEC is pleased to welcome and announce the names and locations of eight Family Medicine Residency Programs (FMRP) that have been selected to participate in the Hereditary Breast Cancer (HBC) Quality Improvement (QI) Pilot Project.  Due to the positive response to the call for participation, we have made room for eight programs to participate.  Congratulations on your acceptance into the QI Pilot Project Collaborative!  We are excited to engage with you to implement this exciting activity. 

Read below to learn about the initiative and to access program updates.

                                                                              Family Medicine Residency Program Participants 

HBC QI Pilot Project Timeline, Training Schedule, Resources, and Data Collection

• December 2023 – Collaborative Group confirmed
• January 2024 – Collaborative Group Orientation
• January/February 2024 – Participants will have completed 3 1- hour webinar trainings: 1) HBC Education and Bring Your Brave CDC Resources; 2) QI Basics; and 3) QI Structure, Measures, Data Collection
• February 2024 – FMRPs collect and report baseline data; develop QI strategies
• February – March 2024 – 1^st QI action period
• March 2024 - Participants report 1^st QI cycle data; QI leaders analyze and share progress with Group
• April – May 2024 – 2^nd QI action period
• June 2024 – Participants report 2^nd QI cycle data; QI leaders analyze and share progress with Group
• June/July 2024 – Group meets to discuss results; Final report

Training Schedule/Registration Links for Participating FMRPs
NOTE:  These trainings are for the participating FMRPs enrolled into the HBC QI Pilot Project. 

• QI Project Leaders:  Please share this information NOW with your FMRP residents and faculty.  For those who miss live sessions, recorded presentations will be posted to the FMEC YouTube Channel for two weeks after each presentation for viewing.  https://www.youtube.com/@FMECInc/videos 

• A link to an online evaluation will be provided at the end of each presentation.  An evaluation must be completed for each training by participating family physicians and residents in order to receive CME and Performance Improvement credits.

 
How to Access the Training Recordings and PDFs of Slide Presentations
These trainings are for the participating FMRP participants enrolled into the HBC QI Pilot Project.  If you were not able to attend a live training, you can access the recordings within a few days of the live training via the links below.  Please view the presentations and complete an evaluation for each training within 2-3 weeks of the live training dates in order to receive, at the end of the project, Performance Improvement/CME credit.  Information on how to complete the online evaluation for each training is included in the recording and at the end of the slide deck.

Hereditary Breast Cancer Education and Bring Your Brave CDC Educational Resources, January 17, 2024
View Recording
View Slides

Quality Improvement Basics, January 25, 2024
View Recording
View Slides

Project Structure, Timeline, and Data Collection Requirements, February 1, 2024
View Recording
View Slides

CME and Performance Improvement Credits

The AAFP has reviewed Family Medicine Education Consortium (FMEC) Hereditary Breast Cancer Quality Improvement Pilot Project and deemed it acceptable for up to 20.00 Performance Improvement AAFP Prescribed credits. Term of Approval is from 12/01/2023 to 07/31/2024. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician's Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.

Acknowledgements
In 2023-2024, ICAAP received a subcontract from the National Association of Chronic Disease Directors (NACDC) to implement an HBC QI Pilot Project. 

Helping Families Communicate About Hereditary Breast or Ovarian Cancer project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $450,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

HBC QI Pilot Project Resources

Below are links to resources we have created for the QI Project Toolbox. 
1)     Hereditary Cancer Resource Folder – Sample Documents Outline
2)     Tools to Assist with Family Cancer History Collection and Assessment
3)     HBC Potential Barriers and Ideas for Change
4)     List of CDC Bring Your Brave Assets Spreadsheet with hyperlinks (some of these materials are available in Spanish)
5)     CDC Breast Cancer Translation Resources and Options
6)     Bring Your Brave Flyer with QR Code (print and display this flyer in your clinics once you begin conducting HBC screening/risk assessment)
7)     Institute for Healthcare Improvement QI Essentials Tool
8)     QI Toolkit PDSA Worksheet
9)     HBC QI Pilot Project PDSA Overview

HBC QI Data Collection
View here: HBC QI Pilot Project Key Clinical Activities, Measures, and Data Collection Requirements

If you have questions about this QI Pilot Project, please contact Kathy Fredericks, MBA, PMP at [email protected].

Background and Project Recruitment
Early detection, in conjunction with risk reduction, is essential to reducing cancer mortality rates. With an estimated ten percent of cancer diagnoses linked to a high-risk genetic mutation (≅ 200,000/year in the United States), identifying and counseling those individuals who carry the mutation can save lives. Family physicians are at the heart of the early detection and prevention of cancer.  They are uniquely positioned to assess their patients' risk and counsel them. This is why the FMEC created the 2023 Hereditary Breast Cancer (HBC)/Narrative Medicine Learning Collaborative (Phase I).  According to the CDC’s Division of Cancer Prevention and Control, only about 41% of primary care physicians refer women with a high risk for breast cancer for genetic counseling and testing.  This QI pilot project aims to increase the number of family physicians and family physician residents who screen for HBC and offer counseling/testing options as well as educational resources. 

The QI Pilot Project Collaborative represents Phase II of our efforts and will run for eight months, December 2023 to July 2024.   
Susanna Evans, MD, FAAFP, Associate Professor and Chair of Family, Community, and Preventive Medicine Drexel University College of Medicine, and faculty with Temple Northwest Community Family Medicine Residency Program, will serve as the lead family physician for the QI activity. 

The HBC QI effort is organized into four areas: 1) utilizing the Bring Your BraveCDC HBC educational resources for providers and patients; 2) implementing a validated breast cancer screening questionnaire in practice; 3) providing patients who screen positive for HBC with genetic counseling; and 4) following patients to encourage ongoing cancer prevention/early detection care.

QI Pilot Project Learning Objectives
At the conclusion of the HBC QI pilot, family physician residents and family physicians in participating clinics will be able to:

1)     Implement the Model for Improvement and Plan, Do, Study, Act (PDSA) cycles of improvement
2)     Understand the risk and incidence of breast and ovarian cancers in young women
3)     Identify and utilize a breast cancer screening tool
4)     Utilize stories, videos, etc. during patient visits
5)     Attain confidence in discussing cancer risk with patients during annual physicals
6)     Increase knowledge of genetic counseling and testing and how to make referrals
7)     Incorporate Bring Your Brave CDC educational resource materials into practice

CME Learning Objectives
Learning Sessions (Live or Recorded Webinars)
This activity includes three training webinars that are required for family physician providers who participate in the QI project.  By the end of each live or recorded webinar, participants will be able to:

Other CME Activities
Participants will also be required to conduct the CME activities below to learn about HBC educational resources and incorporate them into practice.  They will also be required to participate in reviewing and understanding de-identified KCA data at their clinic level and in aggregate across the Collaborative.  This will enable them to learn from one another, and also participate in 1) QI coaching check-ins led by the Project Advisory Committee (PAC) leaders, 2) QI data report outs, and 3) complete the project evaluation.

Requirements

• Learn about CDC Bring Your Brave HBC educational resources for patients and providers and how to use them in practice
• Learn how to incorporate Narrative Medicine into clinical practice by reviewing BYB video resources
• Report and Review De-Identified KCA Patient Data at Baseline and for 2 Plan, Do, Study, Act (PDSA) Cycles; review the data in aggregate and discuss as a Collaborative
• Develop QI Strategies/Implement QI Activities During 2 Action Periods
• Participate and Learn from Learning Collaborative Sessions, Check-Ins, Report Outs, and Evaluation

Performance Improvement/Continuing Medical Education (PICME)
The HBC QI pilot project will guide the learner through each of the three stages of this PICME activity as follows:

Stage A:  Learning from current practice performance assessment
The QI project is overseen by a Project Advisory Committee (PAC) with a QI leader, Dr. Susanna Evans.  The PAC also participated in Phase I of the FMEC's HBC initiative.  Note:  Dr. Perrin's participation on the PAC was through December 2023.

Stage B: Learning from the application of performance improvement to patient care
The FMEC is committed to engaging residency programs and family physicians in practice into learning collaboratives to advance quality healthcare and medical education. Not only can collaboratives improve care and teaching, but they meet the Accreditation Council for Graduate Medical Education (ACGME) cross-institutional collaboration recommendations, which went into effect July 1, 2023. The guidelines state, “Programs are strongly encouraged to partner with other family medicine residency programs through regional learning collaboratives to share resources to facilitate programs and their family medicine practice’s attaining educational and community aims.”  Phase II of this Collaborative builds upon the findings and lessons learned from Phase I by incorporating information learned into an HBC QI pilot project.

Stage C: Learning from evaluation of the performance improvement effort
The HBC QI pilot project includes a robust evaluation.  It is our intent to utilize the findings from Phase II to develop and offer in the future a nation-wide HBC QI initiative, pending funding.  The QI pilot project evaluation includes: 

1)     Apply for exempt QI IRB to be able to present findings at conferences and/or publish in journals
2)     Evaluate 3 CME webinar trainings
3)     Analyze de-identified demographic data from participating residency programs and/or family practice clinics to inform project
4)     Analyze de-identified patient data on key clinical activities (KCAs) at baseline and for 2 PDSA practice improvement cycles
5)     Share baseline and 2 PDSA cycles of data with participants to learn from each other
6)     Utilize PAC members as QI coaches for participating clinics
7)     Administer overall QI project evaluation survey with participants
8)     Analyze project data and disseminate final report
9)     Encourage QI project participants to present their findings at conferences and in posters

What’s included in the structure of this VIRTUAL QI Project?

• 3 CME training webinars
• 20 CME and 20 FP PI Certification Credits
• Support to implement HBC screenings in practice
• Utilization of CDC’s Bring Your Brave educational resources
• Baseline and 2 Follow Up Patient Record Data Collection Cycles
• 2 QI Action Periods 7 Weeks Apart
• Virtual meetings to discuss QI data and improvements made
• Modest incentives for family physician clinics to participate

De-Identified QI Data Collection
Participating family medicine residency clinics will pull 10 unique last seen patient records for female patients ages 18 to 44 years presenting for annual physicals at baseline and for 2 QI cycles (action periods) 7 weeks apart.  De-identified records will be reviewed to track progress in documenting in the patient record whether 1) a breast cancer screening has been conducted.  For positive screens, the records will be further reviewed to look for documentation regarding whether: 1) a positive screen was discussed with the patient, 2) patient HBC educational resources were offered, and 3) a referral has been made for genetic counseling/testing.  

Percent Target Improvement Goals for Key Clinical Activities (KCAs)
By the end of the QI effort, target goals for participating family medicine residency program (FMRP) clinics who see patients that meet the inclusion criteria include:

• 50% of patients will have documented in the patient record that an HBC screening has been completed in the past 12 months. 

Incentives to Participate

• 20 hours of free CME and Family Medicine PI Certification Credits
• Ability to meet Accreditation Council for Graduate Medical Education learning collaborative recommendations
• 1 Computer Tablet or iPad, if requested, to enable clinic staff to share online CDC HBC Bring Your Brave educational resources with patients, or for clinic staff to view online HBC QI project educational trainings
• Access to an assigned FMEC HBC PAC member to serve as a QI coach to support clinic improvement efforts
• $2,500 stipend per Family Medicine Residency Program or family practice clinic to support project participant’s participation (travel, registration fees, etc.) in conferences in 2024 and 2025 (eg. FMEC or Society of Teachers of Family Medicine), ideally to present a poster or a session on their HBC QI efforts.  (QI coaches can provide templates and advice on how to prepare presentations.)
• Assistance connecting to genetic counseling and testing support
• National recognition for participation in a QI activity

 This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) through the National Association of Chronic Disease Directors (NACDD)