INFLUENCE OF KNOWLEDGE AND ATTITUDES ON THE QUALITY OF PHYSICIANS TRANSFUSION PRACTICE

Studies evaluating relationships between physician background characte ristics (e.g. years of practice and medical training) and quality of c are have found few consistent associations. Site of practice variables have been better predictors of quality than have characteristics of i ndividual physicians. This study explores the relationship between phy sicians knowledge and attitudes regarding the use of blood products, a nd the quality of their transfusion practice, based on in-depth physic ian interviews and medical record reviews. The sample includes 296 tra nsfusion episodes ordered by 17 physicians in 2 teaching hospitals. Th e physicians had participated in a larger survey of staff surgeons and anesthesiologists in these hospitals. The quality of transfusion prac tice was defined as the proportion of a physicians' transfusion episod es scored as justified, as determined by explicit chart audit plus imp licit physician review. Large baseline differences were observed betwe en the 2 hospitals; 48% of transfusions in hospital A were justified c ompared with 81% in hospital B. At the physician level, knowledge of t ransfusion indications and receptivity to input from colleagues were s ignificantly associated with higher quality transfusion practice (stan dardized betas=0.41 (P=0.01), and 0.40 (P=0.02), respectively). These findings suggest that in addition to organizational context, physician characteristics may be associated with the quality of care related to a specific clinical practice.