Hereditary Breast Cancer Quality Improvement Pilot Project

Project Overview and Call to Participate - view flyer

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.


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.   

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.

FMEC will provide coaching to up to six family medicine residency programs and/or family physician clinics to help drive development of policies, processes, and improvements to incorporate HBC activities into clinical practice.  We are currently recruiting to enroll family medicine clinics to participate in this activity. 

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.

Website link:    

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.


  • 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, who participated in Phase I of the FMEC’s HBC initiative and will lead the Phase II QI effort. 

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 8 Weeks Apart
  • Virtual meetings to discuss QI data and improvements made
  • Modest incentives for family physician clinics to participate

Proposed Timeline for QI Project

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

De-Identified QI Data Collection

Participating family medicine residency clinics and/or family physician clinics will pull 10 unique last seen patient records for female patients ages 18 to 45 years presenting for annual physicals at baseline and for 2 QI cycles (action periods) 6 to 8 weeks apart.  De-identified records will be reviewed to track progress in documenting in the patient record breast cancer screenings, sharing findings with patients, providing educational resources, and offering counseling or making referrals for genetic counseling/testing.   

Percent Target Improvement Goals for KCAs

By the end of the QI effort, target goals for participating family medicine 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.
  • 50% of HBC screenings are documented in the patient record as having been reviewed with patient.
  • 90% of patients who screen positive for HBC have documented in the record that BYB CDC resources were offered or provided.
  • 90% of patients who screen positive on HBC questionnaire have documented in the record they were offered/referred for genetic counseling.  

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

If you are interested in learning more about this pre-packaged HBC QI pilot project or how to participate, please contact FMEC staff below ASAP.  We are recruiting for this opportunity in October and November of 2023 on a first-come, first-serve basis.  We hope you will join our QI Collaborative!

Kathy Fredericks, MBA, PMP, FMEC QI Consultant:  [email protected]
Scott Allen, MS, FMEC CEO  [email protected]

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)