For some doctors, the professional demands of keeping up with the best practices in the field of medicine may soon steer them in the direction of a personal tutor. Using grants from the Robert Wood Johnson Foundation, a group of specialist societies operating under the umbrella of the American Board of Medical Specialties Research and Education Foundation will concentrate on giving doctors the tools, systems and support they need to give their patients the kind of recommended therapy that has delivered the best outcomes for patients with diabetes and asthma. Practice redesign will figure prominently in the program. And 100 doctors in Colorado and North Carolina are being enlisted to get the pilot program up and running, with an eye to spreading the campaign to every state in the country - funding permitting. "There will be people in the field who are quality improvement experts," says Dr. Sheldon Horowitz, executive director of the ABMS Research and Education Foundation. And they'll help set up physician practices with patient registries, new systems and an education program that will let doctors develop a baseline of statistics to illustrate how they are currently performing compared to recommended practice. The program - dubbed Improving Performance in Practice, or IPIP - is also designed to get doctors to start performing in line with insurers' pay-for-performance programs, giving them a chance to earn higher revenue in exchange for adhering to higher standards. The American Academy of Family Physicians, the American Academy of Pediatrics, the American Board of Family Medicine, the American Board of Internal Medicine and the American Board of Pediatrics have all agreed to help make the program work. Patient registries can offer physicians vital insight into how they're doing, says Horowitz. Treatment methods used for all of a practice's asthma patients, for example, can be pulled together, giving doctors a look at how they're doing overall and where they can make improvements. And they'll be coached on tackling some of the tougher standards of care by which they'll be judged. It isn't enough to give doctors software programs and a set of objectives, says Horowitz. They need hands-on instruction to show them how to assemble the data they'll need for an honest self-appraisal. They have a big task ahead. According to the RAND Corporation, only 55 percent of patients get recommended care - a figure that remains stubbornly resistant to gender, income and race. "We want a mix of practices," adds Horowitz, citing pediatricians and internal family medicine practices as two key target groups. "Not just the most advanced with electronic medical records and at the cutting edge. We also want rural and urban practices to get the right mix." For better or worse, he adds, the country's healthcare system is set up on a state-by-state basis. IPIP's plan is to get the two demonstration projects underway, then expand them to a wider group of physicians in the state before adding new states to the roster. As the group gains experience, it hopes to create five to 10 state programs that can be used as models for the nation as a whole. To make the program sustainable, says Horowitz, the physicians are hoping that insurers and the Centers for Medicare and Medicaid Services will encourage the program by offering financial incentives for better quality. And to help propel it even further, the quality group says that all insurers and government programs should standardize their forms so that a doctor doesn't have to spend large amounts of time duplicating varying requests for information. There are signs that the pilot program may help bring it about. "IPIP will be an excellent vehicle to evaluate the problems in our system and provide support to healthcare teams on the front line trying to solve these problems," says Dr. Marjie Harbrecht, medical director for the Colorado Clinical Guidelines Collaborative. Five of Colorado's major health plans have already agreed to use one set of performance measures and share data across plans, which will reduce confusion in reporting and promote links between IPIP and pay-for-performance programs.