Improvement in Medical Practice Activities

Improvement in Medical Practice Activities (formerly known as Practice Improvement Modules or PIMs) ask diplomates to review at least 30 consecutive patient records associated with a diagnosis or diagnoses seen in their practice, measure their practice performance, develop a plan for improvement, and re-measure the result. These are activities are available online, on-demand. 

Step 1: Select a Diagnosis

Each activity is based on an ophthalmic diagnosis with a specific definition and timeframe requirement. For example, the surgical cataract module is described as: "a patient diagnosed with a cataract that has had a cataract extraction performed by you on one or both eyes and monitored by you at least once during the past six months." Click here for a list of 14 available activities.

To reach the 30 patient chart minimum, you have the option to select:

  • 1 diagnosis using a minimum of 30 patient records;
  • 2 diagnoses using a minimum of 15 patient records per module; or,
  • 3 diagnoses using a minimum of 10 patient records per module.

Pay close attention to the minimum improvement periods noted for each diagnosis as these are hard-stops in the process that cannot be accelerated. Some improvement periods stretch up to 395 days. Although patient data abstracted and re-abstracted within the Improvement in Medical Practice Activity may span across multiple years, if you are in the last year of your MOC cycle and still owe a required activity, you will need to time your activity accordingly to complete it prior to December 31.

Step 2: Review 30 Patient Charts

Reviewing patient charts allows you to reflect on your current practice as it compares to specific performance measures and benchmarks. Based on consensus-driven standards and evidence-based resources, the activities emphasize preferred practice patterns related to the ophthalmic diagnosis. For each patient record reviewed during the chart abstraction, you must be able to provide:

  • Month and year of initial visit
  • Month and year of the most recent visit date
  • Consecutive patient records in order to obtain an accurate snapshot of practice patterns

Direct patient care is required. If you are in a group-partnership or teaching position, exclusive care is not mandatory for selection of patient charts, but you must be actively and directly involved in all reviewed cases.

Step 3: Review Feedback and Design an Improvement Plan

Once you have successfully abstracted 30 consecutive patient records, you will receive an initial feedback report based on your data. Using that report, you'll identify performance measures upon which you'd like to improve, and participate in a simple, step-by-step process for developing an improvement strategy. The total number of charts that will be required for your re-abstraction phase is determined by the measures you select during the development of your improvement plan and whether your selected measures span multiple modules. Please refer to the chart below:

Number of Diagnoses Chosen

Number of Diagnoses Impacted by Chosen Improvement Measures

Number of New Charts Required for Re-measurement

1 diagnosis, 30 patient charts

1 diagnosis

10 patient charts

2 diagnoses, 15 patient charts each

1 diagnosis

10 patient charts

2 diagnoses, 15 patient charts each

2 diagnoses

20 patient charts

3 diagnoses; 10 patient charts each

1 diagnosis

10 patient charts

3 diagnoses, 10 patient charts each

Measures for 2 diagnoses

20 patient charts

3 diagnoses, 10 charts each

Measures for 3 diagnoses

30 patient charts

Step 4: Complete Chart Re-abstraction

Re-abstraction of a new of set of 10-30 consecutive patient charts is required to measure the impact of the improvement strategy. You are encouraged to begin your activity early in the calendar year to allow time to implement your improvement strategies prior to chart re-abstraction. Once you have finished your re-abstraction, the system will generate a second report that compares your new performance data with the your initial results to demonstrate improvement.

Step 5: Write a Brief Impact Statement

The impact statement provides an opportunity to reflect both on the process of self-review and improvement and on the change in performance illustrated in the final report. Your impact statement should focus on the original goal and any relevant data considered as part of the improvement strategy. During the creation of the impact statement, you are encouraged to reflect on the following:

  • Barriers encountered during implementation of the improvement strategy
  • Effective evidenced-based resources you were able to use for the improvement strategy
  • Activities and strategies utilized during the self-improvement process that proved to be effective
  • Changes you considered most important to your practice to maintain or improve performance
  • Approaches to bring about improvement and whether involvement in this activity had a positive impact on others in the practice
  • Whether or not participation in this activity helped you learn more about your practice process or system of care and the benefit it will provide to patients

Upon completion of the Impact Statement, you will have completed the activity.