Document Detail


Ongoing provision of individual clinician performance data improves practice behavior.
MedLine Citation:
PMID:  20529985     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Clinical practice guidelines summarize evidence from science and attempt to translate those findings into clinical practice. Pervasive and consistent adoption of these guidelines into daily provider practice has proven slow.
METHODS: Using postoperative nausea and vomiting (PONV) prophylaxis guideline compliance as our metric, we compared the effects of continuing medical education (CME) alone (I), CME with a single snapshot of provider compliance (II), and ongoing reporting of provider compliance data without further CME (III). We retrospectively analyzed guideline compliance of 23,279 anesthetics at the University of Texas M.D. Anderson Cancer Center. Compliance was defined as a patient with 1 risk factor for PONV receiving at least 1 antiemetic, 2 risk factors receiving at least 2 antiemetics, and 3 risk factors receiving at least 3 antiemetics. Drugs of the same class were counted as single antiemetic administration. Propofol-based anesthetic techniques were counted as receiving 1 antiemetic. Patients with 0 risk factors for PONV were not included. We estimated the compliance rates for each of the 4 time periods of the study adjusting for multiple observations on the same clinician. Individual performance feedback was given once at 6 months after intervention I coincident with a refresher presentation on PONV (start of intervention II) and on an ongoing quarterly basis during intervention III.
RESULTS: Compliance rates were not significantly influenced with CME (intervention I) compared with baseline behavior (54.5% vs 54.4%, P = 0.9140). Significant improvement occurred during the time period when CME was paired with performance data (intervention II) compared with intervention I (59.2% vs 54.4%, P = 0.0002). Further significant improvement occurred when data alone were presented (intervention III) compared with intervention II (65.1% vs 59.2%, P < 0.0001). For patients with 3 risk factors, we saw significant improvement in compliance rates during intervention III (P = 0.0002). In post hoc analysis of overtreatment, the percentage differences between the baseline and time period III decreased as the number of risk factors increased.
CONCLUSIONS: We observed the greatest improvement in guideline compliance with ongoing personal performance feedback. Provider feedback can be an effective tool to modify clinical practice but can have unanticipated consequences.
Authors:
John C Frenzel; Spencer S Kee; Joe E Ensor; Bernhard J Riedel; Joseph R Ruiz
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-06-07
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  111     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-28     Completed Date:  2010-08-26     Revised Date:  2011-03-30    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  515-9     Citation Subset:  AIM; IM    
Affiliation:
M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Mail Stop 409, Houston, TX 77030, USA. jfrenzel@mdanderson.or
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MeSH Terms
Descriptor/Qualifier:
Academic Medical Centers
Anesthesiology / education,  statistics & numerical data*
Antiemetics / therapeutic use*
Attitude of Health Personnel
Chi-Square Distribution
Clinical Competence / statistics & numerical data*
Drug Therapy, Combination
Education, Medical, Continuing / statistics & numerical data*
Employee Performance Appraisal / statistics & numerical data*
Evidence-Based Medicine
Feedback, Psychological
Guideline Adherence
Health Knowledge, Attitudes, Practice
Humans
Linear Models
Outcome and Process Assessment (Health Care) / statistics & numerical data*
Physician's Practice Patterns / statistics & numerical data*
Postoperative Nausea and Vomiting / etiology,  prevention & control*
Practice Guidelines as Topic
Program Development
Quality Indicators, Health Care / statistics & numerical data*
Retrospective Studies
Risk Assessment
Risk Factors
Texas
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antiemetics
Comments/Corrections
Comment In:
Anesth Analg. 2010 Aug;111(2):270-1   [PMID:  20664091 ]
Anesth Analg. 2011 Mar;112(3):737-8; author reply 738   [PMID:  21350233 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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