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 在医疗保健和质量管理项目中，经常提供反馈 信息。然而，使用指导方针来制定质量改进 计划仍然困难；信息需求的个体差异 适当的行动得不到承认；少数人的结果 测试计算机化反馈干预的临床试验 有争议的。 该项目的目的是帮助医疗保健提供者将 将已接受的指南和实践差异数据转化为可测量的个人 质量改进目标，并评估其临床效果。 不同地区小学生临床实习模式的干预研究 关心。 在一项随机对照临床试验中，个性化质量 将测试反馈干预。反馈将由以下人员管理 一种支持a)企业规范的基于规则的专家系统 以及基于推荐的个人质量改进目标 准则和b)落实先前确定的目标 强调个人目标和实际目标之间的差异- 练习模式。试验的地点将是门诊中心 堪萨斯州的一个健康维护组织Humana Health Care Plans 城市。新的个性化质量反馈方法将被用于 执行AHCPR(艾滋病毒阳性)分发的各种指南 无症状患者、抑郁症门诊患者)，由Humana开发 (抗生素处方，糖尿病治疗需要药物治疗)。 43名内科医生和13名执业护士将被随机 被分配参加新的质量管理计划或 接收有关质量的常见反馈信息。均衡分层 将按提供商站点进行。患者将在六个月后进行随访 他们的第一次就诊使他们有资格接受以下建议的护理 指导方针。观察到的主要变量将包括 已确定的符合条件的就诊，订购的建议程序的频率 在符合条件的就诊、专家转介和使用期间，不推荐使用 程序。符合条件的患者的样本量估计为 足以检验基本假设。新的质量管理 我们的干预和对照试验的结果应该具有实际意义 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).