A DECISION-SUPPORT SYSTEM FOR THE ANALYSIS OF CLINICAL-PRACTICE PATTERNS

Several studies documented substantial variation in medical practice p atterns, but physicians often do not have adequate information on the cumulative clinical and financial effects of their decisions. The purp ose of developing an expert system for the analysis of clinical practi ce patterns was to assist providers in analyzing and improving the pro cess and outcome of patient care. The developed QFES (Quality Feedback Expert System) helps users in the definition and evaluation of measur able quality improvement objectives. Based on objectives and actual cl inical data, several measures can be calculated (utilization of proced ure, and expected utilization based on peer-comparison and case-mix ad justment). The quality management rules help to detect important discr epancies among members of the selected provider group and compare perf ormance with objectives. The system incorporates a variety of data and knowledge bases: (i) clinical data on actual practice patterns, (ii) frames of quality parameters derived from clinical practice guidelines , and (iii) rules of quality management for data analysis. An analysis of practice patterns of 12 family physicians in the management of uri nary tract infections illustrates the use of the system.