Changing physicians practices: The effect of individual feedback

Objective. To determine whether physicians who received feedback from six,p eers, six referring/referral physicians, six co-workers, and 25 patients ab out 55 aspects of their medical practices(e.g., able to reach doctor by pho ne after office hours) would make changes to their practices based on that feedback. Method. In an earlier study, 308 physicians were given feedback about 106 a spects of their practices in the form of mean Likert-scale ratings that (1) the peers made on 26 aspects; (2) the referring/referral physicians made o n 23 aspects; (3) the co-workers made on 17 aspects; and (4) the patients m ade on 40 aspects. Three months later 255 of these physicians responded whe n asked to indicate whether they had contemplated or initiated changes,or w hether no change had been necessary, regarding 31 practice aspects, each of which was a summary of one or more of 55 of the original 106 aspects on wh ich they had received ratings. These 55 were considered the aspects most am enable to changeover a short period. The physicians were also asked about t he educational interventions that they felt would help them make changes. M ultivariate analysis of variance was used to see whether the types of chang es reported for the specific aspects of practice were associated with the f eedback ratings received for those aspects. Results. An examination of the-responses showed that 83% of the 255 physici ans reported having contemplated a change, and 66% reported having initiate d a change for at least one aspect of practice. Changes were contemplated m ost frequently for;aspects of practice associated with clinical skills and resource use. Changes were initiated most frequently for aspects of practic e associated with communication with patients and support of patients. Phys icians who contemplated or initiated changes had lower(i.e., more negative) mean ratings than did physicians who reported that no change was necessary , which suggests that the physicians did:use their feedback ratings to deci de about changes,although their:qualitative comments indicated other source s as well. Printed material was chosen most often as a method of receiving continuing medical education related to making changes in the practice area s examined.