By Sarah K. Meadows, MS, CHCP, Manager, Accreditation & Programs, Office of Professional Education; National Jewish Health; and Barbara Goldstein, MD, MMSc, Assistant Professor, Department of Medicine, Division of Rheumatology; National Jewish Health
Posters are a popular presentation format for illustrating research and clinical vignette outcomes. They can efficiently communicate concepts and data to an audience using a combination of visuals and text. However, the actual presentation of the activity design and outcomes data can vary greatly depending upon the audience. The Office of Professional Education at National Jewish Health (NJH) collaborates with clinical faculty at the institution in the development and execution of all of our educational activities, which allows our outcomes data to remain relevant to varied audiences – from CME/CE industry professionals to researchers and clinicians in multiple therapeutic areas.
As part of a larger QI initiative, NJH developed poster presentations in different ways for a variety of conferences. While the initiative remained the same, the emphasis on outcomes data implications was different for each meeting in response to audience interest.
Patients with RA have an increased risk of cardiovascular disease (CVD) as compared to the general population. The European League Against Rheumatism (EULAR) recommends that rheumatologists engage in assessing the CVD risks in RA patients; however, multiple barriers exist, such as limited time and lack of familiarity of CVD screening guidelines, which challenge the feasibility of this practice. Furthermore, recent data suggest that primary care providers fail to assess RA patients consistently or aggressively.1,2
A gap in patient care was identified by the NJH rheumatology and cardiology teams related to RA patients who had modifiable cardiovascular risk factors. Physician leads from each of these clinical areas joined with leads from other NJH departments including Professional Education, Biostatistics, Nursing and Health Initiatives to initiate a 28-month performance and quality improvement project. The project focused on implementing systems-based changes and providing multidisciplinary education. Data from the electronic medical record (EMR), reporting systems from NJH behavioral programs addressing weight management and smoking cessation, and patient surveys are collected and tracked in a project-specific data registry. The overall effort is to demonstrate a systems-based process that can be replicated by other institutions nationwide.
Presenting Outcomes to CME/CE Industry Professionals
Poster preparation for the CME/CE audience considered common interest areas of industry learners — metrics selected to measure healthcare provider performance over time, interventions employed to drive process change through an emphasis on system-level values, and how performance results impacted sustainable change in patient care — in general, a high-level view of the work to indicate implications for how a project fits in the broader system. We developed a poster presentation to highlight these primary areas of interest. Interventions were a central feature of the poster, with a visual depiction of their relationship to organizational priorities (see figure 1). Four Centers for Medicare & Medicaid Services (CMS) Meaningful Use/Physician Quality Reporting System (PQRS) measures identified as priorities for NJH were addressed through the work of this initiative, which increased institutional buy-in and support for critical project interventions like modified order sets in the EMR.3,4 The intervention section of the poster also highlighted patient education materials developed to support clinic process changes.
Presenting Outcomes at Scientific Conferences: What’s the Difference?
Initiative principle investigators (PIs) presented posters at two large scientific association conferences with a learner group comprised of rheumatology practitioners and allied health professionals. Posters were developed in a research framework, playing on the finer data details that are generally sought more in the scientific conference setting. We specifically called out background, methods, results and conclusion, with a primary emphasis on methods and clinical results (see figure 2.) While project metrics, such as referral of RA patients to a cardiology visit and documentation of atherosclerotic cardiovascular disease (ASCVD) 10-year risk score, were referenced in the poster, the methods section focused more broadly on new RA patient workflow processes to address identified cardiovascular risk factors. We noted novel practice changes and the means to obtain the data for description. For example, we highlighted that chart reviews were done for baseline characteristics, recent chest CT scans, medication use, and the review of CT reports in charts by a cardiovascular CT board-certified cardiologist for the presence or absence of coronary calcification to delineate the significance of the studies.
The results section of the poster focused on analysis of clinical and demographic characteristics of the patients included in the study and outcomes of those that engaged in the new RA-CVD process at NJH. In particular, we highlighted that 51 of 104 patients with a chest CT available (49 percent) had some presence of coronary calcifications on chest CT and 39 of those 104 patients (37 percent) were either already on, or started on, a statin. We also emphasized results related to a significant rheumatology metric [multi-dimensional health assessment questionnaires (MDHAQs) were documented on 74 percent of the RA patients] and a significant cardiology metric (24 percent have a documented ASCVD risk score). These were important outcomes to highlight for the conference participants, as prior to the project, we had not done routine assessments or recorded them in our EMR.
The value of an initiative can be communicated in different ways, but is most effective when done in consideration of the targeted learner group. Questions posed by learners at the ACEhp Annual Conference indicated interest in metric selection, engagement of both healthcare teams and the broader organization, and process change facilitation. Questions posed by learners at the ACR and EULAR conferences suggested interest in practical approaches to clinical practices, such as identification of appropriate patient populations and facilitation of referrals, as well as clinical patient outcomes. By highlighting these elements of our single initiative in different ways, we were able to effectively engage each of the learner groups and showcase challenges and successes of the project.
Points for Practice:
- Consider your audience when preparing poster presentations. Much like how we develop CME/CE activity formats and content emphasis based on targeted learners, posters should be planned the same way.
- A general poster preparation approach articulating what was done, how it was done, why it was done and how it contributed to the field of work is a good way to outline any poster presentation content.
- Initiative funded by an educational grant from Pfizer Independent Grants for Learning & Change
- Peters MJ et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010 Feb;69(2):325-31.
- Gossec L et al. Challenges of cardiovascular risk assessment in the routine rheumatology outpatient setting: an observational study of 110 rheumatoid arthritis patients. Arthritis Care Res. 2013 May;65(5):712-7.
- 2014 Clinical Quality Measures. The Centers for Medicare & Medicaid Services website. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ ClinicalQualityMeasures.html. Accessed December 2015.
- Physician Quality Reporting System. The Centers for Medicare & Medicaid Services website. http://www.cms.gov/Medicare/Quality- Initiatives-Patient-Assessment-Instruments/PQRS. Accessed December 2015.