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- Title
Physician Assessment and Feedback During Quality Circle to Reduce Low-Value Services in Outpatients: a Pre-Post Quality Improvement Study.
- Authors
Kherad, Omar; Selby, Kevin; Martel, Myriam; da Costa, Henrique; Vettard, Yann; Schaller, Philippe; Raetzo, Marc-André
- Abstract
<bold>Background: </bold>The impact of the Choosing Wisely (CW) campaign is debated as recommendations alone may not modify physician behavior.<bold>Objective: </bold>The aim of this study was to assess whether behavioral interventions with physician assessment and feedback during quality circles (QCs) could reduce low-value services.<bold>Design and Participants: </bold>Pre-post quality improvement intervention with a parallel comparison group involving outpatients followed in a Swiss-managed care network, including 700 general physicians (GPs) and 150,000 adult patients.<bold>Interventions: </bold>Interventions included performance feedback about low-value activities and comparison with peers during QCs. We assessed individual physician behavior and healthcare use from laboratory and insurance claims files between August 1, 2016, and October 31, 2018.<bold>Main Measures: </bold>Main outcomes were the change in prescription of three low-value services 6 months before and 6 months after each intervention: measurement of prostate-specific antigen (PSA) and prescription rates of proton pump inhibitors (PPIs) and statins.<bold>Key Results: </bold>Among primary care practices, a QC intervention with physician feedback and peer comparison resulted in lower rates of PPI prescription (pre-post mean prescriptions per GP 25.5 ± 23.7 vs 22.9 ± 21.4, p value<0.01; coefficient of variation (Cov) 93.0% vs 91.0%, p=0.49), PSA measurement (6.5 ± 8.7 vs 5.3 ± 6.9 tests per GP, p<0.01; Cov 133.5% vs 130.7%, p=0.84), as well as statins (6.1 ± 6.8 vs 5.6 ± 5.4 prescriptions per GP, p<0.01; Cov 111.5% vs 96.4%, p=0.21). Changes in prescription of low-value services among GPs who did not attend QCs were not statistically significant over this time period.<bold>Conclusion: </bold>Our results demonstrate a modest but statistically significant effect of QCs with educative feedback in reducing low-value services in outpatients with low impact on coefficient of variation. Limiting overuse in medicine is very challenging and dedicated discussion and real-time review of actionable data may help.
- Subjects
OUTPATIENT medical care; PHYSICIANS; PROTON pump inhibitors; ADULTS; CAMPAIGN debates; QUALITY circles; RESEARCH; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies; QUALITY assurance
- Publication
JGIM: Journal of General Internal Medicine, 2021, Vol 36, Issue 9, p2672
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-021-06624-9