INDIVIDUALIZED FEEDBACK TO IMPLEMENT CLINICAL GUIDELINES

遵守公认的实践指南是一个重要的质量问题 在卫生保健和质量管理计划中经常提供反馈 信息.然而，使用指南制定质量改进 计划仍然困难;信息需求的个体差异 适当的行动没有得到承认;少数人的结果 测试计算机反馈干预的临床试验是 争议 该项目的目的是帮助卫生保健提供者翻译 可接受的指南和实践变化数据转化为可测量的个体 质量改进目标，并评估其临床效果 小学不同地区临床实习模式干预 在乎 在随机对照临床试验中， 将对反馈干预进行测试。反馈将由以下人员管理： 一个基于规则的专家系统，支持a）公司的规范 和个人质量改进目标， 准则和B）通过以下方式对先前设定的目标进行跟踪 强调个人目标与实际目标之间的差异- 实践模式。试验地点为门诊中心 Humana Health Care Plans是一家位于堪萨斯的健康维护组织， 市新的个性化质量反馈方法将用于 执行AHCPR分发的各种准则（艾滋病毒阳性 无症状患者，抑郁症门诊患者），并由Humana开发 （抗生素处方，需要药物治疗的糖尿病管理）。 将随机抽取43名医生和13名执业护士， 被指派参与新的质量管理计划或 接收关于质量的常规反馈信息。均衡分层 将由供应商站点执行。患者将在术后6个月接受随访。 他们的第一次访问，使他们有资格获得建议的照顾， 指导方针。观察到的主要变量将包括 确定的合格访视，建议程序的频率 在符合条件的访视、专家转诊期间，以及不推荐使用 程序.合格患者的样本量估计为 足以检验基本假设。新质量管理 干预和我们的对照试验的结果应该有实际的 适用于各种积极管理的医疗保健 组织（例如，HMO、PPO、IPA）。

Compliance with accepted practice guidelines is an important quality issue in health care and quality management programs often provide feedback information. However, the use of guidelines to develop quality improvement programs remains difficult; individual differences in information needs and appropriate actions are not recognized; and results of the few clinical trials testing computerized feedback intervention are controversial. The aim of this project is to assist health care providers in translating accepted guidelines and practice variation data into measurable individual quality improvement objectives and to assess the clinical effect of this intervention on clinical practice patterns in diverse areas of primary care. In a randomized controlled clinical trial, an individualized quality feedback intervention will be tested. The feedback will be administered by a rule-based expert system supporting a) the specification of corporate and individual quality improvement objectives based on the recommended guidelines and b) the follow-up of previously set objectives by highlighting discrepancies between individual objectives and actual- practice patterns. The sites of the trial will be the outpatient centers of Humana Health Care Plans, a health maintenance organization in Kansas City. The new individualized quality feedback method will be used to implement various guidelines distributed by AHCPR (HIV positive asymptomatic patients, depressed outpatients) and developed by Humana (antibiotic prescription, management of diabetes requiring medication). Forty three physicians and 13 nurse practitioners will be randomly assigned to participate in the new quality management program or to receive usual feedback information on quality. Balanced stratification will occur by provider site. Patients will be followed up six months after their first visit which makes them eligible for the care recommended by the guidelines. Observed major variables will include the number of identified eligible visits, frequency of recommended procedures ordered during eligible visits, specialist referrals, and use of not recommended procedures. A sample size of the eligible patients is estimated to be adequate to test the primary hypothesis. The new quality management intervention and the results of our controlled trial should have practical applicability in a wide variety of actively managed health care organizations (e.g., HMO, PPO, IPA).