A Randomized Controlled Trial of CQI Teams and Academic Detailing: Can They Alter Compliance with Guidelines?

Goldberg, Harold I.; Wagner, Edward H.; Fihn, Stephan D.; Martin, Diane P.; Horowitz, Carol R.; Christensen, Dale B.; Cheadle, Allen; Diehr, Paula; Simon, Greg

doi:10.1016/s1070-3241(16)30367-4

Cited by 137 publications

(102 citation statements)

References 27 publications

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“…Refs 20,22,24,29,32,43,50,62,63,80,114,115,121,123,129,139,140,145,156,161,[172][173][174]178,179,190,187,193,194,210,215. c The contamination not avoided group here consisted of 21 studies from the Refs 31,35,39,42,76,84,100,104,125,138,163,165,167,171,191,198,209. avoided studies, the mean sample size is 64.5 and for studies where contamination was not avoided, the mean sample size is 451.3; both datasets have very large variance and a simple test of mean difference between the samples shows no evidence to suggest equality of the me...…”

Section: Subset Of Higher Quality Studiesmentioning

confidence: 99%

Contamination in trials of educational interventions

Keogh-Brown¹,

Bachmann²,

Shepstone³

et al. 2007

Health Technol Assess

124

112

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment ProgrammeT he Health Technology Assessment (HTA) programme, now part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the costs, effectiveness and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care. The research findings from the HTA Programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA Programme is needs-led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in the NHS, the public and consumer groups and professional bodies such as royal colleges and NHS trusts. These suggestions are carefully prioritised by panels of independent experts (including NHS service users). The HTA Programme then commissions the research by competitive tender. Secondly, the HTA Programme provides grants for clinical trials for researchers who identify research questions....

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Section: Subset Of Higher Quality Studiesmentioning

confidence: 99%

Contamination in trials of educational interventions

Keogh-Brown¹,

Bachmann²,

Shepstone³

et al. 2007

Health Technol Assess

124

112

View full text Add to dashboard Cite

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“…The response to "automated" prompts can quickly extinguish as physicians' attention to them declines; a phenomenon known as "alert fatigue" 14 . Conversely, there is strong evidence that physicians do respond well to professional "opinion leaders" in a specific content area and/or academic detailing 15 . The objectives of this study were to evaluate whether a unique EMR-based intervention combined with the use of opinion leaders could reduce medication use and the number of falls in an ambulatory elderly population at risk for falls.…”

Section: Introductionmentioning

confidence: 99%

An Electronic Medical Record (EMR)-Based Intervention to Reduce Polypharmacy and Falls in an Ambulatory Rural Elderly Population

2008

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BACKGROUND: Falls are the leading cause of injuryrelated deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls. OBJECTIVE:The objectives of this study were to evaluate an EMR-based intervention to reduce overall medication use, psychoactive medication use, and occurrence of falls in an ambulatory elderly population at risk for falls. DESIGN:Prospective, randomized by clinic site. PATIENTS/PARTICIPANTS:Six-hundred twenty community-dwelling patients over 70 at risk for falls based on age and medication use. INTERVENTIONS:A standardized medication review was conducted and recommendations made to the primary physician via the EMR. MEASUREMENTS AND MAIN RESULTS:Patients were contacted to obtain self reports of falls at 3-month intervals over the 15-month period of study. Fall-related diagnoses and medication data were collected through the EMR. A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the 2 groups, adjusting for baseline medication patterns and comorbidities. Although the intervention did not reduce the total number of medications, there was a significant negative relationship between the intervention and the total number of medications started during the intervention period (p <.01, regression estimate −0.199) and the total number of psychoactive medications (p<.05, regression estimate −0.204.) The impact on falls was mixed; with the intervention group 0.38 times as likely to have had 1 or more fall-related diagnosis (p<.01); when data on self-reported falls was included, a nonsignificant reduction in fall risk was seen. CONCLUSIONS:The current study suggests that using an EMR to assess medication use in the elderly may reduce the use of psychoactive medications and falls in a community-dwelling elderly population.

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“…With few exceptions (e.g., Westphal, Gulati, and Shortell 1997;Shortell et al 2000), most have used perceptual measures of impact or self-reported estimates of cost or clinical impact rather than objectively derived measures of clinical quality (Gilman and Lammers 1995;Shortell et al 1995b). Other multisite, comparative studies have explicitly examined the impact of hospital QI on clinical practice (Carlin, Carlson, and Nordin 1996;O'Connor et al 1996;Gordian and Ballard 1997;Goldberg et al 1998;Ferguson et al 2003). However, nearly all of these studies focused on a single clinical quality indicator (e.g., risk-adjusted mortality for coronary artery bypass surgery [CABG], adverse drug event) or single clinical practice (e.g., immunization, guideline use) rather than a broad range of measures indicative of quality at an institutional level.…”

Section: Introductionmentioning

confidence: 99%

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Weiner

Alexander

Shortell

et al. 2005

Health Services Research

140

106

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Objective. To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality. Data Sources. Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance. Study Design. Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. Data Collection/Abstraction Methods. Moreover, as much as one-third of some hospital procedures expose patients to risks without improving their health; one-third of drugs prescribed are not indicated; and one-third of laboratory tests showing abnormal results do not get followed up by clinicians (Dubois and Brook 1988;Brook et al. 1990;Leape 1994; Institute of Medicine 2000).Many believe that quality improvement (QI) represents a promising strategy for improving hospital quality of care. QI is a systemic approach to planning and implementing continuous improvement in performance. QI emphasizes continuous examination and improvement of work processes by teams of organizational members trained in basic statistical techniques and problem solving tools and empowered to make decisions based on their analysis of the data. The systemic focus of QI complements a growing recognition in the field that the quality of the care delivered by clinicians depends substantially on the performance capability of the organizational systems in which they work. While individual clinician competence remains important, many increasingly see the capability of organizational systems to prevent errors, coordinate care among settings and practitioners, and ensure that relevant, accurate information is available when needed as critical elements in providing high quality care (Institute of Medicine 2000). Reflecting the growing emphasis on organizational systems of care, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, and the Peer Review Organizations of the Centers for Medicare and Medicaid have all encouraged hospitals to use QI methods.Although QI holds promise for improving quality of care, hospitals that adopt QI often struggle with its implementation (Shortell, Bennett, and Byck 1998). By implementation, we refer to the transition period, following a decision to adopt a new idea or practice, when intended users put that new idea or practice into use--for example, when clinical and nonclinical staff begin applying QI principles and practices to improve clinical care processes ( et al. 2004). In addition, the systemic nature of many quality problems implies that the effectiveness of a QI initiative may depend on its implementation across many conditions, disciplines, and departme...

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A Randomized Controlled Trial of CQI Teams and Academic Detailing: Can They Alter Compliance with Guidelines?

Cited by 137 publications

References 27 publications

Contamination in trials of educational interventions

Contamination in trials of educational interventions

An Electronic Medical Record (EMR)-Based Intervention to Reduce Polypharmacy and Falls in an Ambulatory Rural Elderly Population

Quality Improvement Implementation and Hospital Performance on Quality Indicators

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