Requirements for Performance Improvement Activities

Performance improvement activities improve targeted aspects of participants’ medical practice through an extended, evidence-based, three-part program.

To award AMA PRA Category 1 Credit™ for PI activities, you must satisfy these requirements:

  • Establish an oversight mechanism to ensure content integrity of the selected performance measures. This mechanism must clearly specify required data elements and it must use feasible data collection methods.
  • Provide learners with clear instructions that define the activity’s educational process and establish how to claim credit.
  • Provide learners with adequate information to understand the performance measures that will guide their PI activity, and the evidence base that supports those measures.
  • Document the depth of physician participation and report this data to the CME office.
  • Document each of the activity’s stages. Our office has procedures to help you document participants’ assessment of their practice, learning, and intervention implementation.


Although physicians can receive credit for completing individual stages of the PI activity, your activity should integrate all three stages as described below to promote the maximum improvement in your participants’ patient care.

Stage A: Assess Current Practice

Assess current practice using appropriate performance measures such as chart reviews. Participating physicians may ask their staff to gather basic data, but should perform their own analyses. This stage generally involves some reflective writing on what the physicians’ data indicates about their practice.

Stage B: Implement the Intervention

This central stage incorporates learning via some type of CME, and applying that knowledge as an intervention in clinical practice. Participants might learn a surgical technique at grand rounds or a method for communicating with patients in a workshop, for example. As the provider, you will help your participating physicians implement this knowledge and assess changes in their performance.

Account for the specific traits of the physicians’ patients in developing assessment standards: for example, how many patients with a given condition must the physician see, over what period of time, to produce a valid assessment? Use suitable tracking tools such as flow sheets to measure the intervention’s success.

Stage C: Evaluate the Intervention

Using data analysis, discussion, and techniques such as reflective writing, help your participants compare the results of implementing the intervention to their initial assessment of their practice. Summarize the changes in practice, process, and patient outcomes, and consider the implications of these changes for their practice going forward.

Why Performance Improvement Activities?

The performance improvement (PI) initiative helps physicians improve their practice using evidence-based analysis and intervention strategies. Individuals or groups of physicians learn a specific method to improve their performance, assess their current practice, apply the new measures over a useful interval, and re-evaluate their performance at the end of this interval.

PI activities are the most intensive and often the most rewarding kind of CME we sponsor. In recognition of this, physicians completing a full PI program earn 20 AMA PRA Category 1 Credits™.

A PI activity may address any facet of a physician’s practice that has direct implications for patient care.


Physicians can earn 5 AMA PRA Category 1 Credits™ for each stage of a performance improvement activity. They do not need to complete all three stages to receive credit, but those who do complete the entire program can earn an additional 5 AMA PRA Category 1 Credits™  credits, for a total of 20.