Education in Quality Improvement for Pediatric Practice: An Online Program to Teach Clinicians QI



      Education in Quality Improvement for Pediatric Practice (EQIPP) is an online program designed to improve evidence-based care delivery by teaching front-line clinicians quality improvement (QI) skills. Our objective was to evaluate EQIPP data to characterize 1) participant enrollment, use patterns, and demographics; 2) changes in performance in clinical QI measures from baseline to follow-up measurement; and 3) participant experience.


      We conducted an observational study of EQIPP participants utilizing 1 of 3 modules (asthma, immunizations, gastroesophageal reflux disease) from 2009 to 2013. Enrollment and use, demographic, and quality measure data were extracted directly from the EQIPP system; participant experience was assessed via an optional online survey.


      Study participants (n = 3501) were diverse in their gender, age, and race; most were board certified. Significant quality gaps were observed across many of the quality measures at baseline; sizable improvements were observed across most quality measures at follow-up. Participants were generally satisfied with their experience. The most influential module elements were collecting and analyzing data, creating and implementing aim statements and improvement plans, and completing “QI Basics.”


      Online educational programs, such as EQIPP, hold promise for front-line clinicians to learn QI. The sustainability of the observed improvements in care processes and their linkage to improvements in health outcomes are unknown and are an essential topic for future study.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • US Institute of Medicine; Committee on Quality of Health Care in America
        Crossing the Quality Chasm: A New Health System for the 21st Century.
        National cademies Press, Washington, DC2001
        • Mangione-Smith R.
        • DeCristofaro A.H.
        • Setodji C.M.
        • et al.
        The quality of ambulatory care delivered to children in the United States.
        N Engl J Med. 2007; 357: 1515-1523
        • McGlynn E.A.
        • Asch S.M.
        • Adams J.
        • et al.
        The quality of health care delivered to adults in the United States.
        N Engl J Med. 2003; 348: 2635-2645
        • Swing S.R.
        The ACGME outcome project: retrospective and prospective.
        Med Teach. 2007; 29: 648-654
      1. American Board of Medical Specialties (ABMS) and the ABMS Maintenance of Certification (ABMS MOC) Program. Fact sheet. Available at: Accessed May 12, 2014.

        • Miles P.V.
        Maintenance of certification: the role of the American Board of Pediatrics in improving children’s health care.
        Pediatr Clin North Am. 2009; 56: 987-994
        • Pronovost P.J.
        • Miller M.R.
        • Wachter R.M.
        • Meyer G.S.
        Perspective: Physician leadership in quality.
        Acad Med. 2009; 84: 1651-1656
        • Combes J.R.
        • Arespacochaga E.
        Lifelong Learning: Physician Competency Development. American Hospital Association’s Physician Leadership Forum.
        American Hospital Association, Chicago, Ill2012 (Available at:) (Accessed May 12, 2014)
        • Auerbach A.D.
        • Landefeld C.S.
        • Shojania K.G.
        The tension between needing to improve care and knowing how to do it.
        N Engl J Med. 2007; 357: 608-613
        • Shojania K.G.
        • Grimshaw J.M.
        Evidence-based quality improvement: the state of the science.
        Health Aff (Millwood). 2005; 24: 138-150
        • Headrick L.A.
        • Barton A.J.
        • Ogrinc G.
        • et al.
        Results of an effort to integrate quality and safety into medical and nursing school curricula and foster joint learning.
        Health Aff (Millwood). 2012; 31: 2669-2680
      2. IHI 90-Day R&D Project Final Summary Report: Approaches to Training Faculty at Academic Medical Centers to Ensure That Clinical Trainees Become Effective Improvers. Institute for Healthcare Improvement, Cambridge, Mass2011 (Available at:) (Accessed May 12, 2014)
        • McKenna M.K.
        • Richart S.
        • Tyler S.
        Impact of educational interventions on physician performance and patient outcomes.
        CE Meas. 2008; 2: 2-6
        • Marinopoulos S.S.
        • Dorman T.
        • Ratanawongsa N.
        • et al.
        Effectiveness of continuing medical education.
        Evid Rep Technol Assess (Full Rep). 2007; : 1-69
        • Davis D.
        • O’Brien M.A.
        • Freemantle N.
        • et al.
        Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?.
        JAMA. 1999; 282: 867-874
        • Davis D.A.
        • Thomson M.A.
        • Oxman A.D.
        • Haynes R.B.
        Changing physician performance. A systematic review of the effect of continuing medical education strategies.
        JAMA. 1995; 274: 700-705
        • Oxman A.D.
        • Thomson M.A.
        • Davis D.A.
        • Haynes R.B.
        No magic bullets: a systematic review of 102 trials of interventions to improve professional practice.
        CMAJ. 1995; 153: 1423-1431
        • Mazmanian P.E.
        • Davis D.A.
        Continuing medical education and the physician as a learner: guide to the evidence.
        JAMA. 2002; 288: 1057-1060
        • Boonyasai R.T.
        • Windish D.M.
        • Chakraborti C.
        • et al.
        Effectiveness of teaching quality improvement to clinicians: a systematic review.
        JAMA. 2007; 298: 1023-1037
        • Lannon C.
        • Dolins J.
        • Lazorick S.
        • et al.
        Partnerships for Quality project: closing the gap in care of children with ADHD.
        Jt Comm J Qual Patient Saf. 2007; 33: 66-74
        • Lazorick S.
        • Crowe V.L.
        • Dolins J.C.
        • Lannon C.M.
        Structured intervention utilizing state professional societies to foster quality improvement in practice.
        J Contin Educ Health Prof. 2008; 28: 131-139
        • Langley G.J.
        The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.
        2nd ed. Jossey-Bass, San Francisco, Calif2009
      3. American Board of Pediatrics. 2012 workforce data. Available at: Accessed May 12, 2014.

        • Cook D.A.
        • Levinson A.J.
        • Garside S.
        • et al.
        Instructional design variations in Internet-based learning for health professions education: a systematic review and meta-analysis.
        Acad Med. 2010; 85: 909-922
        • Lam-Antoniades M.
        • Ratnapalan S.
        • Tait G.
        Electronic continuing education in the health professions: an update on evidence from RCTs.
        J Contin Educ Health Prof. 2009; 29: 44-51
        • Cook D.A.
        • Levinson A.J.
        • Garside S.
        • et al.
        Internet-based learning in the health professions: a meta-analysis.
        JAMA. 2008; 300: 1181-1196
        • Wutoh R.
        • Boren S.A.
        • Balas E.A.
        eLearning: a review of Internet-based continuing medical education.
        J Contin Educ Health Prof. 2004; 24: 20-30
        • Cook D.A.
        Web-based learning: pros, cons and controversies.
        Clin Med. 2007; 7: 37-42
        • Shojania K.G.
        • Silver I.
        • Levinson W.
        Continuing medical education and quality improvement: a match made in heaven?.
        Ann Intern Med. 2012; 156: 305-308
        • Batalden P.
        • Davidoff F.
        Teaching quality improvement: the devil is in the details.
        JAMA. 2007; 298: 1059-1061