Engaging physicians in change: results of a safety net quality improvement program to reduce overuse.
Engaging physicians in change: results of a safety net quality improvement program to reduce overuse.
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DOI：
10.1177/1062860610373380
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发表时间：
2011-01
期刊：
影响因子：
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通讯作者：
Beckman H
中科院分区：
文献类型：
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作者：
Cammisa C;Partridge G;Ardans C;Buehrer K;Chapman B;Beckman H
识别、理解和处理临床变异是促进适当护理的有用工具，同时有助于控制医疗保健成本。虽然准确、相关和有用的数据在这个过程中很重要，但成功地让医生改变行为往往是最重大的挑战。利用商业上可用的变化分析过程，加州医疗补助管理的医疗计划确定了显著的网络实践模式变化。一组专家小组制定了一项策略，以减少过度使用已确定的5种行为。通过对小组使用这5种行为的前后比较来评估干预措施。在干预前，麻醉剂、肌肉松弛剂、磁共振成像（MRI）和脊髓注射每月增加8%至18%。干预后，趋势逆转。在肌肉松弛剂使用、麻醉剂使用、整体MRI使用和脊柱注射方面，差异有统计学意义（P < 0.0001）。同伴比较数据和尊重反馈与过度使用模式的显著变化有关。
Identifying, understanding, and addressing clinical variation is a useful tool to promote appropriate care while helping control health care costs. Although accurate, relevant, and useful data are important in the process, successfully engaging physicians to change behavior is often the most significant challenge. Using a commercially available variation analysis process, a California Medicaid managed care plan identified significant network practice pattern variation. A team of panel practitioners then developed a strategy to reduce overuse of 5 identified behaviors. The intervention was evaluated using a pre–post comparison of the panel’s use of the 5 behaviors. During the preintervention period, narcotics, muscle relaxants, magnetic resonance imaging (MRI), and spinal injections increased between 8% and 18% per month. Postintervention, the trends reversed. The differences were statistically significant (P < .0001) for muscle relaxant use, narcotic use, overall MRI use, and spinal injections. Peer comparison data and respectful feedback was associated with significant change in patterns of overuse.