Ci. Kiefe et al., Improving quality improvement using achievable benchmarks for physician feedback - A randomized controlled trial, J AM MED A, 285(22), 2001, pp. 2871-2879
Citations number
78
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Context Performance feedback and benchmarking, common tools for health care
improvement, are rarely studied in randomized trials. Achievable Benchmark
s of Care (ABCs) are standards of excellence attained by top performers in
a peer group and are easily and reproducibly calculated from existing perfo
rmance data.
Objective To evaluate the effectiveness of using achievable benchmarks to e
nhance typical physician performance feedback and improve care.
Design Group-randomized controlled trial conducted in December 1996, with f
ollow-up through 1998.
Setting and Participants Seventy community physicians and 2978 fee-for-serv
ice Medicare patients with diabetes mellitus who were part of the Ambulator
y Care Quality Improvement Project in Alabama.
Intervention Physicians were randomly assigned to receive a multimodal impr
ovement intervention, including chart review and physician-specific feedbac
k (comparison group; n=35) or an identical intervention plus achievable ben
chmark feedback (experimental group; n=35).
Main Outcome Measure Preintervention (1994-1995) to postintervention (1997-
1998) changes in the proportion of patients receiving influenza vaccination
; foot examination; and each of 3 blood tests measuring glucose control, ch
olesterol level, and triglyceride level, compared between the 2 groups.
Results The proportion of patients who received influenza vaccine improved
from 40% to 58% in the experimental group (P<.001) vs from 40% to 46% in th
e comparison group (P=.02). Odds ratios (ORs) for patients of achievable be
nchmark physicians vs comparison physicians who received appropriate care a
fter the intervention, adjusted for preintervention care and nesting of pat
ients within physicians, were 1.57 (95% confidence interval [CI], 1.26-1.96
) for influenza vaccination, 1.33 (95% CI, 1.05-1.69) for foot examination,
and 1.33 (95% CI, 1.04-1.69) for long-term glucose control measurement. Fo
r serum cholesterol and triglycerides, the achievable benchmark effect was
statistically significant only after additional adjustment for physician ch
aracteristics (OR, 1.40 [95% CI, 1.08-1.82] and OR, 1.40 [95% CI, 1.09-1.79
], respectively).
Conclusion Use of achievable benchmarks significantly enhances the effectiv
eness of physician performance feedback in the setting of a multimodal qual
ity improvement intervention.