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Titolo:
Improving quality improvement using achievable benchmarks for physician feedback - A randomized controlled trial
Autore:
Kiefe, CI; Allison, JJ; Williams, OD; Person, SD; Weaver, MT; Weissman, NW;
Indirizzi:
Univ Alabama, Div Prevent Med, Birmingham, AL 35205 USA Univ Alabama Birmingham AL USA 35205 revent Med, Birmingham, AL 35205 USA Univ Alabama, Ctr Outcomes & Effectiveness Res & Educ, Birmingham, AL 35205 USA Univ Alabama Birmingham AL USA 35205 Res & Educ, Birmingham, AL 35205 USA Univ Alabama, Div Gen Internal Med, Birmingham, AL 35205 USA Univ AlabamaBirmingham AL USA 35205 ternal Med, Birmingham, AL 35205 USA Univ Alabama, Sch Nursing, Birmingham, AL 35205 USA Univ Alabama Birmingham AL USA 35205 ch Nursing, Birmingham, AL 35205 USA Univ Alabama, Dept Hlth Serv Adm, Birmingham, AL 35205 USA Univ Alabama Birmingham AL USA 35205 h Serv Adm, Birmingham, AL 35205 USA
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 22, volume: 285, anno: 2001,
pagine: 2871 - 2879
SICI:
0098-7484(20010613)285:22<2871:IQIUAB>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE MYOCARDIAL-INFARCTION; HEALTH-CARE QUALITY; CLINICAL BENCHMARKING; DIABETES-MELLITUS; US ADULTS; IMPACT; PERFORMANCE; OUTCOMES; MEDICARE; INTERVENTIONS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
78
Recensione:
Indirizzi per estratti:
Indirizzo: Kiefe, CI Univ Alabama, Div Prevent Med, 1717 11th Ave S,MT 700, Birmingham, AL 35205 USA Univ Alabama 1717 11th Ave S,MT 700 Birmingham AL USA 35205 USA
Citazione:
C.I. Kiefe et al., "Improving quality improvement using achievable benchmarks for physician feedback - A randomized controlled trial", J AM MED A, 285(22), 2001, pp. 2871-2879

Abstract

Context Performance feedback and benchmarking, common tools for health care improvement, are rarely studied in randomized trials. Achievable Benchmarks of Care (ABCs) are standards of excellence attained by top performers ina peer group and are easily and reproducibly calculated from existing performance data. Objective To evaluate the effectiveness of using achievable benchmarks to enhance typical physician performance feedback and improve care. Design Group-randomized controlled trial conducted in December 1996, with follow-up through 1998. Setting and Participants Seventy community physicians and 2978 fee-for-service Medicare patients with diabetes mellitus who were part of the Ambulatory Care Quality Improvement Project in Alabama. Intervention Physicians were randomly assigned to receive a multimodal improvement intervention, including chart review and physician-specific feedback (comparison group; n=35) or an identical intervention plus achievable benchmark feedback (experimental group; n=35). Main Outcome Measure Preintervention (1994-1995) to postintervention (1997-1998) changes in the proportion of patients receiving influenza vaccination; foot examination; and each of 3 blood tests measuring glucose control, cholesterol level, and triglyceride level, compared between the 2 groups. Results The proportion of patients who received influenza vaccine improvedfrom 40% to 58% in the experimental group (P<.001) vs from 40% to 46% in the comparison group (P=.02). Odds ratios (ORs) for patients of achievable benchmark physicians vs comparison physicians who received appropriate care after the intervention, adjusted for preintervention care and nesting of patients within physicians, were 1.57 (95% confidence interval [CI], 1.26-1.96) for influenza vaccination, 1.33 (95% CI, 1.05-1.69) for foot examination, and 1.33 (95% CI, 1.04-1.69) for long-term glucose control measurement. For serum cholesterol and triglycerides, the achievable benchmark effect wasstatistically significant only after additional adjustment for physician characteristics (OR, 1.40 [95% CI, 1.08-1.82] and OR, 1.40 [95% CI, 1.09-1.79], respectively). Conclusion Use of achievable benchmarks significantly enhances the effectiveness of physician performance feedback in the setting of a multimodal quality improvement intervention.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 16/07/20 alle ore 16:40:17