A Behavioral Intervention to Improve Obstetrical Care

Althabe, Fernando; Buekens, Pierre; Bergel, Eduardo; Belizán, José M.; Campbell, Marci K.; Moss, Nancy; Hartwell, Tyler; Wright, Linda L.

doi:10.1056/nejmsa071456

Cited by 153 publications

(167 citation statements)

References 22 publications

(1 reference statement)

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“…Out of 8,104 de-duplicated titles and abstracts, nine studies were deemed relevant in our review. [16][17][18][19][20][21][22][23][24] Review of full text articles led to exclusion of three studies because the intervention was not relevant [22][23][24] and one study because it was a feasibility study. 21 Five relevant randomized controlled trials met the full inclusion criteria (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…[16][17][18][19][20] Five cluster randomized controlled trials (RCT) examining educational interventions for seeking, appraising, and applying evidence from systematic reviews in decision-making by clinicians were identified (Tables 1). [16][17][18][19][20] A meta-analysis of study outcomes was not possible due to the heterogeneity in the format of the interventions, the settings, and clinical areas being addressed.…”

Section: Resultsmentioning

confidence: 99%

“…All studies reported follow-up of professionals suffi-ciently. [16][17][18][19][20] Allocation concealment was not done for two studies 19,20 and was unclear for one study. 16 For selective reporting, Gülmezoglu et al 17 were not able to report on one practice at follow-up due to the inability to measure.…”

Section: Quality Assessment Resultsmentioning

confidence: 99%

“…19,20 Concerns for both studies lay in the lack of rigor related to data collection. 19,20 Data collectors were not blinded to whether a hospital was part of the intervention or control group in the study performed by Althabe and colleagues. 19 Clinicians were aware of the treatment of interest and reported their own outcomes.…”

Section: Quality Assessment Resultsmentioning

confidence: 99%

“…19,20 Data collectors were not blinded to whether a hospital was part of the intervention or control group in the study performed by Althabe and colleagues. 19 Clinicians were aware of the treatment of interest and reported their own outcomes. which were not corroborated or assessed for accuracy in the trial conducted by Clarkson et al 20 …”

Section: Quality Assessment Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Interventions Encouraging the Use of Systematic Reviews in Clinical Decision-Making: A Systematic Review

et al. 2010

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Quality Assessment Resultsmentioning

confidence: 99%

Section: Quality Assessment Resultsmentioning

confidence: 99%

Section: Quality Assessment Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Interventions Encouraging the Use of Systematic Reviews in Clinical Decision-Making: A Systematic Review

et al. 2010

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Using Science to Improve the Nation's Health System

Lauer¹,

Collins²

2010

JAMA

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Evaluation of a Peer-to-Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse

et al. 2019

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IMPORTANCE Mohs micrographic surgery (MMS) is a skin cancer treatment that uses staged excisions based on margin status. Wide surgeon-level variation exists in the mean number of staged resections used to treat a tumor, resulting in a cost disparity and question of appropriateness. OBJECTIVE To evaluate the effectiveness of a behavioral intervention aimed at reducing extreme overuse in MMS, as defined by the specialty society, by confidentially sharing stages-per-case performance data with individual surgeons benchmarked to their peers nationally. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled intervention study included 2329 US surgeons who performed MMS procedures from January 1, 2016, to March 31, 2018. Physicians were identified using a 100% capture of Medicare Part B claims. The intervention group included physicians affiliated with the American College of Mohs Surgery, and the control group included physicians not affiliated with the American College of Mohs Surgery. INTERVENTIONS Individualized performance reports were delivered to all outlier surgeons, defined by the specialty society as those with mean stages per case 2 SDs above the mean, and inlier surgeons in the intervention group. MAIN OUTCOMES AND MEASURES The primary outcome was surgeon-level change in mean stages per case between the prenotification (January 2016 to January 2017) and postnotification (March 2017 to March 2018) periods. A multivariable linear regression model was used to evaluate the association of notification with this surgeon-level outcome. The surgeon-level metric of mean stages per case was not risk adjusted. The mean Medicare cost savings associated with changes in practice patterns were calculated. RESULTS Of the 2329 included surgeons, 1643 (70.5%) were male and 2120 (91.0%) practiced in metropolitan areas. In the intervention group (n = 1045), 53 surgeons (5.1%) were outliers; in the control group (n = 1284), 87 surgeons (6.8%) were outliers. Among the outliers in the intervention group, 44 (83%) demonstrated a reduction in mean stages per case compared with 60 outliers in the control group (69%; difference, 14%; 95% CI of difference, −1 to 27; P = .07). There was a mean stages-per-case reduction of 12.6% among outliers in the intervention group compared with 9.0% among outliers in the control group, and outliers in the intervention group had an adjusted postintervention differential decrease of 0.14 stages per case (95% CI, −0.19 to −0.09; P = .002). The total administrative cost of the intervention program was $150 000, and the estimated reduction in Medicare spending was $11.1 million. CONCLUSIONS AND RELEVANCE Sharing personalized practice pattern data with physicians benchmarked to their peers can reduce overuse of MMS among outlier physicians.

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A Behavioral Intervention to Improve Obstetrical Care

Abstract: A multifaceted behavioral intervention increased the prophylactic use of oxytocin during the third stage of labor and reduced the use of episiotomy. (ClinicalTrials.gov number, NCT00070720 [ClinicalTrials.gov]; Current Controlled Trials number, ISRCTN82417627 [controlled-trials.com].).

Cited by 153 publications

References 22 publications

Interventions Encouraging the Use of Systematic Reviews in Clinical Decision-Making: A Systematic Review

Interventions Encouraging the Use of Systematic Reviews in Clinical Decision-Making: A Systematic Review

Using Science to Improve the Nation's Health System

Evaluation of a Peer-to-Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse

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