We gratefully acknowledge the invaluable contributions of our faculty content developers, Kevin Hill, MD, Michael Hsu, MD, Saeed Ahmed, MD, and Michael Goedde, MD, in crafting this educational material.

Target Audience: This activity is designed to improve the competence, performance, and patient outcomes of physicians, physician assistants, nurses, nurse practitioners and other health care professionals. Learners will determine individual practice gaps and address them through a performance improvement plan. Learners will assess and evaluate performance techniques used in their practices.

Our goal: The overall objective of this activity is to guide you through the process of self-evaluation using evidence-based clinical quality measures. Once practices are implemented as an everyday clinical function, it is expected that you will have achieved performance change in your practice setting.  

Educational objectives of this activity: At the conclusion of this activity, clinicians will be able to:

• Describe assessment of hazardous cannabis use and cannabis use disorder (CUD), co-occurring substance  use disorders, and other co-occurring psychiatric and medical conditions.
• Make appropriate treatment recommendations for hazardous cannabis use, CUD and cannabis withdrawal.
• Explain the individual characteristics of potential medications for cannabis use disorder and cannabis withdrawal.
• Demonstrate understanding of clinically appropriate application of psychosocial treatments, referrals to appropriate providers, levels of care, or community-support groups.
• Understand clinical indications for and how to best use urine and other toxicology.
• Demonstrate improved performance in working with patients with cannabis use disorder.

Core Competencies as a result of participating in this continuing education activity: 

• Interpersonal Skills and Communication
• Medical Knowledge
• Patient Care
• Practice-based Learning and Improvement

The stages of this PIP activity: This PIP activity follows the AMA-standardized three-stage process of a PI CME that includes: 

• Stage A - Assess: Assess your current practice against current evidence, expert consensus, and peers' practice; 
• Stage B - Apply: Develop and follow your own improvement plan; 
• Stage C - Evaluate: Reassess your practice to measure the effects of your improvement plan.

A minimum of 1 month must pass from the beginning to the final stage, but it is likely (and recommended) that the process will take 3-6 months.

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This activity is a Performance Improvement CME (PI CME). It is an activity intended to guide a participant through a series of steps to gauge practice change over time based on clinical measures provided throughout Stages A, B, and C. During Stage B, learners implement interventions to improve performance related to these measures over a useful interval of time (see AMA).

• Note: Stage B is the stage that lasts the longest since it requires that there be time to apply the interventions to a sufficient number of patients and for a sufficient amount of time in order to be able to evaluate the impact of the intervention(s) (see AMA FAQs).

Stage A: Data Collection: Assess your practice behaviors.

• Review introductory material. Expected duration 30-60 minutes.

• Review the Clinical Quality Measures of this PIP

• Review 5 patient charts where utilizing these techniques were considered. Expected duration 30-60 minutes.

Stage B: Application and Intervention: Develop and follow your own improvement plan. 

• We will provide you with tools to evaluate your current practice.

• Develop a quality improvement plan. You will identify areas in need of improvement and construct an effective performance improvement plan for change. Having reviewed your chart audit data, you will identify at least one clinical measure to improve while accessing PIP tools to support and sustain the changes.

• You will be given the opportunity to ask five (5) of your patients to evaluate your practice. 

• It is likely (and recommended) that Stage B may take 3-6 months to complete.  In Stage B, you will construct an effective performance improvement plan utilizing PIP tools in order to implement change on the measure you identified in Stage A.

Stage C: Reassessment and Review: Reassess your practice to measure the effects of your improvement plan (post intervention measurement).  

• You will reassess performance via chart audit by again selecting 5 patient charts for reassessment and entering non-identifying data as before.