Instructions: In the official Proposal Form below, you may save your progress and return several times before submitting, using the Save and Continue link at the bottom of each page.

Provide the numbers,  as available, of health care providers who are participating in this QI Effort (regardless of claiming MOC Part IV through the Portfolio Program). [Standard C2, C3]

13.     What is the specific aim of the quality improvement effort? The Aim Statement should include: (1) a specific and measureable improvement goal, (2) a specific target population, and (3) a specific target date/time period. [Standard: B3, C1, C2]

14.     Add a row for each measure used in the QI Effort, if known.
[Standard: B4, B6, C1]

NOTES: You must at least complete, at a minimum, the patient population at this point. It is desirable, though not required, to have at least one outcome, process and balancing measure.

15.     Describe the types of interventions and tools that are being, were, or will be used by participants In the QI Effort and describe how each is expected to impact individual practice and patient care, if known. [Standard: B7]

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  NOTES: You must complete, at a minimum, the impact on patient care and individual practice at this point. If you do not know interventions/tools at this point, indicate "Unknown at this time”.

16.      Indicate the requirements for an individual to meaningfully participate in this QI Effort CHECK All REQUIREMENTS THAT APPLY TO THIS QI EFFORT [Standard B7, B6, B7, C1, C2, C3]

Optional Information

Attach any relevant files regarding the quality improvement effort that you wish to share with the Portfolio Program reviewers. (This  file will appear as an attachment in your submission confirmation email)

When you submit this form, you will receive a confirmation email which will include your form responses. Emails can take up to 24 hrs to arrive.

What Happens Next:

Your submission will be read within 48 hours, and you should receive an email receipt shortly from

“NYU Winthrop CME Registrar”.

If all elements are complete:

• We assign it for Peer Review to one or more Board Certified Physician(s)
• Your Peer Reviewer may contact you with feedback prior to making a recommendation of approval/revision
• Once all Peer Review is complete, we will contact you with an approval/revision decision
• Your project will be entered into the ABMS website MOCAM Activity Manager for tracking of the project QI data
• Once on the MOCAM Activity Manager website, the project will be eligible to enroll additional participants(local/national project scopes)
• Participants will fulfill satisfactory completion criteria via MOCAM
• At Project conclusion, Participant data will be transmitted to ABMS and the relevant member board for the participants who completed the project