Applying for MOC Part IV Credit

The following processes are involved in designating and receiving Part IV Credit for participation in a QI project:

1. Identifying a QI activity appropriate for Part IV credit designation
2. Outlining the QI project to check eligibility for Part IV Maintenance of Certification (MOC) and other planning related to the project
3. Submitting a report on the completed QI project for Part IV MOC to be approved
4. Individual physicians attesting to their participation on the QI project

Each of these steps is described briefly below with links to relevant information and resources.

1. Identifying a QI activity appropriate for Part IV Credit designation

Several factors should be considered in selecting a QI project to be designated for Part IV credit.

• Will physicians be engaged in a systematic effort of reviewing and improving some aspect(s) of care or care delivery for their patients?
• Will the project be sustained, involving at least two or more linked PDSA cycles of performance review and improvement effort? The post-intervention data and review from one cycle become the baseline data and planning for the next cycle.
• Does the project address one or more of the National Academy of Medicine dimensions?
• Is the project substantive and clear?
• Will physicians view the project as important to their practice and/or Dartmouth Health?
• Will physicians be able to actively participate in the project?

2. Outlining the QI project to check eligibility for Part IV MOC and other planning related to the project

The lead of the QI project should check with a member of the Part IV MOC Program staff regarding whether the design of a project is suitable for Part IV and to address other planning issues. This discussion is greatly simplified by the project lead considering in advance:

1. Structured problem solving - logic underlying a project
2. A timeline for the two linked cycles of improvement
3. A worksheet outlining activities that will meet requirements
4. Enrolling physicians who want their participation documented

Each of these activities is explained below.

A. Structured problem solving - logic underlying a proposed initial cycle

Planning an improvement cycle involves identifying:

• Problem to address
• General goal and specific aim(s) (measureable and timeframe for achievement)
• Main underlying (root) causes of the problem
• Interventions that address major causes
• Operational plans to implement the interventions

A framework for describing these elements of a plan and their relationships is presented in this planning tool: Structured Problem Solving Logic Diagram for a Proposed Improvement Cycle (PDF).

Describing the full logic for an improvement cycle typically occurs after the problem is identified and baseline data are collected. After baseline data are collected and discussed, the aims, underlying causes, interventions, and operational plans can be specified.

For projects with two linked cycles, the initial intervention will likely alter the underlying causes to be addressed in the second cycle. Therefore the elements are described separately for the planning of each cycle. Although the description in the worksheet will be in narrative text, project leaders can use the "Logic Diagram" planning tool to outline content, organize, and simplify writing the narrative description.

B. Timeline draft for two linked PDSA cycles of improvement

After thinking through the logic and plan to initiate the first improvement cycle, project leaders will want to lay out an overall plan for the two cycles of the project. Sequencing several interrelated activities over many months requires careful thought regarding how long each activity will likely take.

The Timeline Draft for a QI Project with two Linked Cycles (DOCX). This planning tool helps project leaders list the time frame for each major project activity. To the right of each major activity is space to note the relevant date or time period for the project being planned.

C. A worksheet outlining activities that will meet requirements

All MOC Part IV projects will follow the DMAIC framework and must include two linked PDSA cycles. With the logic for the first cycle of improvement and the timeline for project activities in mind, the project leader can outline an overview of the plan for the overall project. Major activities should be described on the QI Activity Form. Some of the specific activities for the second improvement cycle may not be known. For preliminary purposes it is sufficient to note when later activities will occur. For example, if the initial intervention has not yet occurred, for underlying causes at the beginning of the second cycle, note "To be determined after post-intervention data are collected."

The purpose of the Worksheet is to show that the project is structured with appropriate activities over two linked cycles of improvement.

Send a Worksheet to Dartmouth Health Part IV Program (theresa.m.gilbane@hitchcock.org). We will follow up to discuss the proposed project and its potential appropriateness for Part IV credit designation.

After the Dartmouth Health Part IV Program staff are in agreement on the appropriateness of the outlined project, a copy will be forwarded to the clinical leader identified on the worksheet to confirm the appropriateness of the project within the specific clinical setting.

D. Faculty participation in a QI project

Identifying physicians who want their participation documented for Part IV MOC helps a project lead assure these physicians receive appropriate information and participate in required activities.

Please use the participation form here to enroll in an existing QI Project: Faculty Participation in a QI Project (DOCX).

Dartmouth Health Part IV Program staff work with Project Leaders to enroll physicians who want their participation documented.

3. Submitting a report on the completed QI project for Part IV MOC for approval

Report on a QI project eligible for Part IV MOC

When a project is complete, please submit the completed worksheet to theresa.m.gilbane@hitchcock.org. Before completing the report, the project should have been checked by the MOC Part IV staff, including completing and submitting a preliminary worksheet for review of eligibility.

Approving QI projects for Part IV credit

Dartmouth Health Part IV Program staff will review the completed worksheet to determine that the project has been carried out with appropriate QI methods and the expected engagement of participating physicians. Project leads (if appropriate) will be contacted regarding questions.

The report form has been designed to assure that the ABMS Part IV MOC Portfolio Program requirements are met for each Dartmouth Health QI project designated for MOC Part IV. Dartmouth Health uses the evaluation criteria and scoring shown on Evaluation for QI Projects for MOC Part IV (DOCX). These criteria are similar to those used by ABMS in auditing QI projects.

4. Physicians attesting to their participation in the QI project

When the QI project has been completed and approved, Dartmouth Health Part IV Program staff will provide the Physician Attestation form to participating physicians.

This form must be fully completed and returned to the Dartmouth Health MOC Office or Project Leader.

If there are multiple participants on a project, attestation forms will be reviewed by the Project Leader and then returned to the Dartmouth Health MOC Part IV staff.