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Component 4 – Practice Performance Assessment and Improvement (PPA)

The subject for this edition of the OCC Corner is Component 4 – Practice Performance Assessment and Improvement (PPA).  The PPA Component of Osteopathic Continuous Certification is a NEW requirement for maintaining board certification.

Each physician in OCC must engage in continuous quality improvement through the comparison of their personal practice performance measured against national standards for orthopedic surgery.

The Practice Performance Assessment and Improvement component is module based, requiring the completion of one module during each three-year CME cycle.  The AOBOS has developed 15 preliminary modules in conjunction with the American Osteopathic Academy of Orthopedics (AOAO).

Modules have been developed in following topic areas:

  • Peri-Operative Care for Total Hip/Total Knee and Hip Fracture
  • Distal Radius Fracture
  • Herniated Lumbar Disc Treated Operatively
  • Knee Arthroscopy
  • Informed Consent
  • Non-Operative Carpal Tunnel
  • Operative Carpal Tunnel
  • Pediatric Supracondylar Humerus Fracture
  • Non-Operative Ankle Fracture
  • Operative Ankle Fracture
  • Peri-Operative Safety
  • Orthopedic OMT
  • Non-Operative Shoulder Impingement
  • Operative Shoulder Impingement
  • Lower Extremity Long Bone Intramedullary Nailing

Each module is available online on the Osteopathic-CAT system website, www.ostcat.com, and will consist of a physician logging ten (10) consecutive cases, in the module topic area, from the physician’s personal practice.  The individual physician’s module results will be measured against national standards.  If the results fall below acceptable thresholds, there will be a required educational activity followed by a reassessment in the same module with 10 new consecutive cases.  All physician logged cases are subject to audit.

Since these modules take some time to complete, it is highly recommended each physician begins their required module in the first or second year of the CME cycle.

An example of one of the Practice Performance Assessment and Improvement Modules is presented below.

Module 1Peri-Operative Care for Total Hip/Total Knee and Hip Fracture

  1. Has patient been risk assessed for DVT?
  2. Was DVT prophylaxis administered?
  3. Were IV antibiotics administered within one (1) hour of incision?
  4. Were IV antibiotics discontinued within 24 hours?
  5. If a Foley catheter was used, was it discontinued within SCIP guidelines?
  6. Did discharge instructions include instructions for progressively increasing mobility?

Working with the online PPA Modules

All of the AOBOS’ Practice Performance Assessment and Improvement (PPA) modules are delivered online through software developed by Meaningful Measurement’s Osteopathic-CAT (Physicians Continuous Assessment & Training) system.

Before you can enter chart information into the O-CAT system, you will be required to complete a user profile.  O-CAT will assign your user id to the email address entered in the registration process.

The screen below is the opening screen you will see each time you use O-CAT by either clicking on the link from the OCC page of the AOBOS website or going to the Osteopathic-CAT website at www.ostcat.com 

To create your User Login information, click the red HERE link to enter your profile information.


For established users, enter your login information in the blue box.

When using the Osteopathic-CAT system for the first time, you will be required to pay the $295.00, three year subscription fee to gain unlimited access to all of the orthopedic surgery PPA modules as well as other core competency modules developed by Meaningful Measurements to fulfill the Component 4 requirements. 

Since the AOBOS does not use a voucher system for the subscription fee, you will click on the ‘DO NOT USE VOUCHER CODE TO REGISTER’ button.

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You will then enter your profile information and click on the "PAY NOW AND REGISTER" button.  Once the registration process is completed, you will move to the Home screen of the Osteopathic-CAT system.

From this Home screen you can access the orthopedic surgery PPA modules by clicking on the PPAs option and choosing PPA topics.  Choose the module you would like to complete from the list of orthopedic surgery PPA modules.


For information on how to use the PPA module software, online instructions are available  on this Home screen from the drop-down list under PPAs.

Additional information/help for the Osteopathic-CAT system can be accessed from the FAQ and HOW TOs available from this same menu bar at the top of the Home screen.  For any questions or issues requiring more involved support for the PPAs, choose the ‘Contact Us’ option for one on one help.


Once the data for the 10 consecutive charts is entered for the PPA module, and the module is finished, the AOBOS will be notified and you will receive an email with the assessment of the results.  The individual physician’s module results will be measured against national standards and either be approved as complete (meeting or exceeding the benchmarks) or sent back for remediation.  If remediation is required, the suggested PPA educational activity will be required.  After completion of the educational portion of the process, 10 new consecutive charts in the same PPA module topic will need to be collected to reassess the topic and show improvement over the first module results.   Once improvement in the module topic is measured, the module will be marked as complete.

The AOA’s OCC software platform will be notified of the successful module completion and the AOA will assign CME credit for successfully finishing the PPA component. 

Ten category 1B credits will be issued for the successful completion of the module.  These credits also count toward the 15 self-assessment credits required in the CME component of OCC.

Additional OCC Information
AOBOS Board members will be available to answer your OCC questions at the AOAO’s Annual Meeting in Rancho Palos Verdes, CA at the OCC Booth in the Exhibitor’s Hall.
Link to the AOBOS OCC Handbook - http://www.aobos.org/mm/files/OCC-Handbook-Master.pdf
Link to the Component 4 PPA modules - http://www.osteopathic-cat.com/ 

Check out the OCC Corner in each new edition of the Orthopod for updates to OCC.

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