It's been several years since practice gaps became a requirement in healthcare NCPD, but I frequently find that the concept still causes confusion. I think that this stems from the fact that we need to identify both practice gaps and educational needs, which means that they are not the same thing. If you've been in the field for a while, maybe this will offer a new way to explain these interrelated concepts to your colleagues. And if you're new to the field, I hope this helps with any confusion you might have.Practice Gaps
I remember when practice gaps became a thing, and I remember spending hours explaining to people what that meant.But of the two concepts covered in this post, practice gaps have an official definition from the ACCME:
The difference between health care processes or outcomes observed in practice, and those potentially achievable on the basis of current professional knowledge (2019)
I typically tell people (while using broad hand gestures that simply don't translate well to the written word) that there is what's happening right now and what should be happening. And that's the gap.
The gap describes the what. What are healthcare providers doing that they shouldn't be doing? Or what are healthcare providers not doing that they should be doing? But both parts need to be stated in order to see what the gap is, and that is where I find most mistakes are made in identifying a practice gap.
This is not a practice gap because we don't know how many patients should receive an annual flu shot. Perhaps the clinic's population is primarily immunocompromised individuals who cannot receive any immunizations. So that 25% may be great! We have no way of knowing based on this statement.
This also is not a practice gap. We know what the goal is, but we don't know if that goal is being met. If we don't know the current vaccination rate, we don't know if there even is a gap.
Once we put the two parts together, we have a practice gap. We know the current state (25%) and we know the goal (95%). Most practice gaps have hard numbers like this. They are usually something that can be measured quantitatively. Hopefully they aren't as broad as my made-up example, but they could be.
So we've identified the what. And that leads us to the next step of understanding the problem.Educational Needs
Why? Going back to my flu shot example, why are only 25% of patients receiving flu shots when the goal is for 95% to receive them?
Maybe there's something systemic – the EHR/EMR isn't reminding providers that the patient has yet to receive a flu shot. That's a tech issue, not an educational one. We can't really address that using an educational activity.
Maybe providers are offering the flu shot, but patients are refusing. We don't need numbers to prove this. If providers say they are seeing this happen in their practice, that's good enough. And it is something that can be addressed by education.
But we probably should drill down a bit farther. Why are patients refusing the vaccine? And why are providers not helping patients change their minds? Here we see two different educational needs:
Now, depending on the scope of your program, you could feasibly design an activity or series of activities to address both of these needs. But most of us really are focused on the provider side of things, so that second need is where most educational activities lie.Putting It Together
If we take our practice gap (flu vaccination rates are at 25% when they should be at 95%) and our educational need (providers need better communication skills related to the flu vaccine), we can design an activity. It could be a Performance Improvement (PI-CME) activity in which each provider is assessed independently to see how their rates line up with their colleagues. It could be a simulation course in which providers practice talking to patients about the flu vaccine. It could be a combination of things. But by identifying a broad issue (the gap) and then drilling down to what is causing it (the need), we are able to create educational activities that are meaningful to our learners and, hopefully, improve the health of the individuals they serve.
ACCME (2019). FAQ Topics: In Criterion 2, what is meant by "professional practice gap?". Available at: https://www.accme.org/faq/criterion-2-what-meant-professional-practice-gap