Physician Assessment and Feedback During Quality Circle to Reduce Low-Value Services in Outpatients: a Pre-Post Quality Improvement Study.

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State: Public
Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_B68C37A145D5
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Physician Assessment and Feedback During Quality Circle to Reduce Low-Value Services in Outpatients: a Pre-Post Quality Improvement Study.
Journal
Journal of general internal medicine
Author(s)
Kherad O., Selby K., Martel M., da Costa H., Vettard Y., Schaller P., Raetzo M.A.
ISSN
1525-1497 (Electronic)
ISSN-L
0884-8734
Publication state
Published
Issued date
09/2021
Peer-reviewed
Oui
Volume
36
Number
9
Pages
2672-2677
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
The impact of the Choosing Wisely (CW) campaign is debated as recommendations alone may not modify physician behavior.
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.
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.
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.
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.
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.
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.
Keywords
Adult, Feedback, General Practitioners, Humans, Male, Management Quality Circles, Outpatients, Practice Patterns, Physicians', Quality Improvement, Choosing Wisely, educative feedback, low-value care, overuse
Pubmed
Web of science
Open Access
Yes
Create date
11/02/2021 11:23
Last modification date
05/10/2021 5:40
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