PARTNERING WITH PHYSICIANS TO ACHIEVE QUALITY IMPROVEMENT

Background: The Main Medical Assessment Foundation (MMAF) has successf ully involved hundreds of Main physicians in study groups to analyze d ata on small-area variation and assess physician decision-making patte rns. In 1991 the MMAF model was replicated across a tri-state area (Ma in, New Hampshire, Vermont) in an effort called the Outcomes Dissemina tion Project, which is funded by a five-year grant from the U.S. Agenc y for Health Care Policy and Research. The Outcomes Dissemination Proj ect: Five specialty study groups, each meeting three times a year, exa mine local and national utilization data, examine guidelines and resea rch findings, participate in outcomes studies and patient education, a nd disseminate their findings through specialty society presentations and other feedback efforts. The MMAF study group process is based on t he beliefs that medicine is a subculture with a complex set of profess ional values, beliefs, socialization processes, and norms, and that qu alify improvement efforts work best when they are nonpunitive and educ ational. Issues in obtaining physician involvement: (1) Physicians are willing to change their practices if they are brought into a cultural ly appropriate improvement program. (2) Related specialties (for examp le, internists and family practitioners) can often work together effec tively on issues of common interest (3) Involving respected clinical l eaders has helped establish the legitimacy of MMAF methods among physi cians. (4) Area- and physicians-specific data are not made public, so as to build a sense of confidentiality among participants. Conclusions : The project continues to function as a powerful education process an d serves as a model for replication elsewhere.