Personalised physician learning intervention to improve hypertension and lipid control: randomised trial comparing two methods of physician profiling.
Personalised physician learning intervention to improve hypertension and lipid control: randomised trial comparing two methods of physician profiling.
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DOI：
10.1136/bmjqs-2014-002807
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发表时间：
2014-12
影响因子：
5.4
通讯作者：
Margolis KL
中科院分区：
文献类型：
--
作者：
O'Connor PJ;Magid DJ;Sperl-Hillen JM;Price DW;Asche SE;Rush WA;Ekstrom HL;Brand DW;Tavel HM;Godlevsky OV;Johnson PE;Margolis KL
To assess the impact of personalized physician learning (PPL) interventions using simulated learning cases on control of hypertension and dyslipidemia in primary care settings. A total of 132 primary care physicians, 4,568 eligible patients with uncontrolled hypertension, and 15,392 eligible patients with uncontrolled dyslipidemia were cluster-randomized to one of three conditions: (a) no intervention, (b) PPL-electronic medical record (EMR) intervention in which 12 PPL cases were assigned to each physician based on observed patterns of care in the EMR in the previous year, or (c) PPL-ASSESS intervention in which 12 PPL cases were assigned to each physician based on their performance on four standardized assessment cases. General and generalized linear mixed models were used to account for clustering and to model differences in patient outcomes in the study arms. Among patients with uncontrolled hypertension at baseline, 49.1%, 46.6%, and 47.3% (P=0.43) achieved BP targets at follow up. Among patients with uncontrolled dyslipidemia at baseline, 37.5%, 37.3%, and 38.1% (P=0.72) achieved low-density lipoprotein cholesterol targets at follow up in PPL-EMR, PPL-ASSESS, and the control group, respectively. Although both systolic blood pressure (BP) (P<.001) and lipid (P<.001) values significantly improved during the study, the group-by-time interaction term showed no differential change in systolic BP values (P=0.51) or lipid values (P=0.61) among the three study arms. No difference in intervention effect was noted when comparing the PPL-EMR with the PPL-ASSESS intervention (P=0.47). The two PPL interventions tested in this study did not lead to improved control of hypertension or dyslipidemia in primary care clinics during a mean 14-month follow-up period. This null result may have been due in part to substantial overall improvement in BP and lipid control at the study sites during the study.
