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Allocation of Physicians to Review Type

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Preamble

The College of Physicians of Nova Scotia, by way of the provincial Medical Act must ensure physicians participate in a practice assessment program. As such, the College’s Practice Enhancement Program aims to promote a culture of continuous quality improvement within the profession, enhancing competence and ensuring the provision of safe medical care.

Guided by the emerging body of literature linking practice quality to a physician’s individual and practice factors, our Practice Enhancement Program streams physicians according to “need”. The program implements a “physician factors rubric” designed to stream physicians into three types of quality improvement activities. For example, a physician with more risk factors such as advanced age, professional isolation, lack of certification and repeated disciplinary issues is directed to an On-site practice review. A physician with more supports in practice, such as evidence of directed continuing professional development, practising within a shared or team environment and teaching is directed to develop a Professional Learning Plan or to participate in an Off-site practice review.

Procedure

On an annual basis, physicians deemed eligible for the Practice Enhancement Program (PEP) will receive a “Physician Factors” rubric score. Scores will be ranked and physicians will be randomly selected from one of three ranked levels of risk: Low, Moderate and High.

Practice Enhancement Activities

Physicians with lower rubric scores are associated with less risk for practice quality concerns and will be randomly selected to complete a Professional Learning Plan. This quality improvement activity will be structured under the Physician Practice Improvement model and will include engagement with a College-appointed peer-support physician to assist the physician in identifying areas for practice improvement, directing their continuing professional development (CPD) activities.

Physicians whose rubric scores rank in the “mid-range” and have a balance of supportive and risk factors will be randomly selected to participate in an Off-site review of their practice. A College-appointed peer reviewer will remotely access the physician’s patient records and perform a peer review of their documentation and clinical care. This audit and feedback method of review will provide the physician with an assessment of their practice, identify gaps in practice quality and inform a practice improvement plan that directs their CPD.

Physicians with higher rubric scores, associated with risk for practice quality concerns, will be randomly selected to participate in an On-site Peer Review of their practice. A College-appointed peer reviewer will visit the physician’s practice location, review the physician’s practice facilities and their medical record keeping via a random selection of patient records. The On-site review of the physician’s practice will provide the physician with an assessment of their practice, identify gaps in practice quality and inform a practice improvement plan that directs their CPD.

Outcomes of Activities

Physicians who have completed their PEP activity through the completion of their practice improvement plan, and have few or no concerns as a result of the review will be considered complete and deemed to have “met the requirements of PEP”.

During the course of PEP participation, physicians may be advanced to other PEP activities. For example, if during the course of the Off-site review medical record keeping is insufficient to draw a clear conclusion regarding the quality of practice or provide meaningful feedback for practice improvement; or the review raises questions or concerns that can only be properly addressed by a more comprehensive practice review, a physician may be required to undergo an On-site review.

Referral to the Practice Enhancement Committee (PEC)

Reviewed physicians will be referred to the Practice Enhancement Committee (PEC) under the following circumstances:

  • Information gathered in the course of the On-site review is insufficient to draw a clear conclusion regarding the quality of practice or provide meaningful feedback for practice improvement;
  • A review raises concerns regarding the quality of practice or approach to practice improvement, sufficient to merit consideration of directed peer support and/or early reassessment; or
  • Randomly, for the purpose of program quality assurance.
Applicable Legislation: Medical Act of Nova Scotia – Section 64
Approved by: Practice Enhancement Committee; Assessment Committee; Council
Approval Date(s):December 2, 2022 & December 9, 2022
Review Date:December 2024