Effect of Peer Comparison Letters for High-Volume Primary Care Prescribers of Quetiapine in Older and Disabled Adults

Sacarny, Adam; Barnett, Michael L.; Le, Jackson; Tetkoski, Frank; Yokum, David; Agrawal, Shantanu

doi:10.1001/jamapsychiatry.2018.1867

Cited by 89 publications

(117 citation statements)

References 30 publications

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“…We feel that, beyond educational interventions, the peer pressure generated by the continuous open benchmarking played a determinant role in the success of our strategy. 33 The direct laboratory costs showed a significant growth reduction (secondary outcome); we have however to acknowledge that we have only stopped the growing in the request of tests and that we are probably still far away from a reasonable baseline.…”

Section: Discussionmentioning

confidence: 90%

“…The implementation of a centralised web‐based system, accessible to every health care provider involved in the care of the hospitalised patients, delivering unmasked data, called “Reporting Wisely,” yielded substantial reductions in the number of lab tests and volume of blood withdrawals per patient (primary and secondary outcome, respectively). We feel that, beyond educational interventions, the peer pressure generated by the continuous open benchmarking played a determinant role in the success of our strategy . The direct laboratory costs showed a significant growth reduction (secondary outcome); we have however to acknowledge that we have only stopped the growing in the request of tests and that we are probably still far away from a reasonable baseline.…”

Section: Discussionmentioning

confidence: 95%

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A multi‐level strategy for a long lasting reduction in unnecessary laboratory testing: A multicenter before and after study in a teaching hospital network

et al. 2018

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Summary Background Reducing unnecessary laboratory blood testing in the hospital setting represents a challenge to improve the adequacy of healthcare and a tricky task for teaching hospitals. Our hospital network actively participates in the Choosing Wisely Campaign and is engaged in avoiding unnecessary low value interventions and investigations. We aimed to study whether a multi‐level approach combining educational and web‐system based interventions, could be effective in reducing laboratory testing and related costs. Methods Multicenter, proof of concept, prospective, observational, before and after study, in a network of public hospitals in Switzerland. All patients admitted between 1 January 2015 and 31 December 2017 were analyzed. A multi‐level strategy based on online continuous monitor benchmarking and educational support was applied in the internal medicine services. The primary outcome was a significant reduction in the number of laboratory tests per patient and per day during the hospital stay. Secondary outcomes were reduction in the blood sample volume taken per patient and per day in laboratory costs. Results Over the 36 months of the study, 33 309 admissions were analyzed. A significant reduction of laboratory tests per patient and per day of hospitalisation was found:–11%, P ‐value<0.001; –6%, P ‐value <0.001. The mean monthly blood volume, per patient and per day of hospital stay and laboratory costs per patient was also significantly reduced: –7%, P ‐value<0.05; –3%, P ‐value<0.01, and –17%, P ‐value<0.01, respectively. Conclusions The obtained reduction in the number of laboratory tests, blood volume withdrawn and related costs, support the idea that an open web‐based system, involving all health care providers, coupled with educational interventions, can be helpful in generating awareness of prescriber habits and to catalyze changes in their behaviour. The peer pressure related to the unmasked benchmarking process did probably play a determinant role.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 95%

A multi‐level strategy for a long lasting reduction in unnecessary laboratory testing: A multicenter before and after study in a teaching hospital network

et al. 2018

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“…Similarly, peer benchmarking also substantially changed physician behavior in a cohort of physicians who received peer comparison letters about their high-volume prescribing frequency of quetiapine in older patients. 37 Finally, in a study at our institution, we observed a reduction in unnecessary blood transfusions among surgeons who were given a transfusion report accounting for case type, complexity, and comorbidity relative to peers 34 and are now applying the model in a national collaborative to reduce opioid overprescribing in narcotic-naive patients after standardized procedures. 38 These studies demonstrate that physicians with outlier practice patterns can be identified using claims data and that individual physician-level feedback can have an impact on the problem of lowvalue and unnecessary care.…”

Section: Discussionmentioning

confidence: 90%

Overuse of early peripheral vascular interventions for claudication

Hicks

Holscher

Wang

et al. 2020

Journal of Vascular Surgery

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Objective: Guidelines from the Society for Vascular Surgery and the Choosing Wisely campaign recommend that peripheral vascular interventions (PVIs) be limited to claudication patients with lifestyle-limiting symptoms only after a failed trial of medical and exercise therapy. We sought to explore practice patterns and physician characteristics associated with early PVI after a new claudication diagnosis to evaluate adherence to these guidelines. Methods:We used 100% Medicare fee-for-service claims to identify patients diagnosed with claudication for the first time between 2015 and 2017. Early PVI was defined as an aortoiliac or femoropopliteal PVI performed within 6 months of initial claudication diagnosis. A physician-level PVI utilization rate was calculated for physicians who diagnosed >10 claudication patients and performed at least one PVI (regardless of indication) during the study period. Hierarchical multivariable logistic regression was used to identify physician-level factors associated with early PVI.Results: Of 194,974 patients who had a first-time diagnosis of claudication during the study period, 6286 (3.2%) underwent early PVI. Among the 5664 physicians included in the analysis, the median physician-level early PVI rate was low at 0% (range, 0%-58.3%). However, there were 320 physicians (5.6%) who had an early PVI rate $14% ($2 standard deviations above the mean). After accounting for patient characteristics, a higher percentage of services delivered in ambulatory surgery center or office settings was associated with higher PVI utilization (vs 0%-22%; 23%-47%: adjusted odds ratio [aOR], 1.23; 48%-68%: aOR, 1.49; 69%-100%: aOR, 1.72; all P < .05). Other risk-adjusted physician factors independently associated with high PVI utilization included male sex (aOR, 2.04), fewer years in practice (vs $31 years; 11-20 years: aOR, 1.23; 21-30 years: aOR, 1.13), rural location (aOR, 1.25), and lower volume claudication practice (vs $30 patients diagnosed during study period; #17 patients: aOR, 1.30; 18-29 patients: aOR, 1.35; all P < .05). Conclusions:Outlier physicians with a high early PVI rate for patients newly diagnosed with claudication are identifiable using a claims-based practice pattern measure. Given the shared Society for Vascular Surgery and Choosing Wisely initiative goal to avoid interventions for first-line treatment of claudication, confidential data-sharing programs using national benchmarks and educational guidance may be useful to address high utilization in the management of claudication. (J Vasc Surg 2020;71:121-30.)

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“…27 Both the content and author/sender of the memo in this study were likely also key to the intervention's success. 28 In this case, the emailed memo was signed/sent by the CEO of the physicians' clinically integrated network and endorsed by the leadership of the health system's primary care group. Indeed, behavioral literature suggests that authority of the writer gives the Figure 3.…”

Section: Discussionmentioning

confidence: 99%

Modifying Provider Vitamin D Screening Behavior in Primary Care

et al. 2020

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Purpose: Clinical evidence shows minimal benefit to vitamin D screening and subsequent treatment in the general population. This study aims to assess the effectiveness of 2 light-touch interventions on reducing vitamin D test orders. Methods: The outcomes were weekly average vitamin D rates, computed from adult primary care encounters (preventive or nonpreventive) with a family medicine (FM) or internal medicine (IM) provider from June 14, 2018 through December 12, 2018. We conducted an interrupted time series analysis and estimated the cost impact of the interventions. The interventions consisted of an educational memo (August 9, 2018) distributed to providers and removal of the vitamin D test (FM: August 15, 2018; IM: October 17, 2018) from the providers' quick order screen in the electronic health record. Change in order rates were analyzed among physicians (MDs and DOs), physician assistants (PAs), and nurse practitioners (NPs). Results: There were 587,506 primary care encounters (FM = 367,947; IM = 219,559). Vitamin D order rates decreased from 6.9% (FM = 5.1%; IM = 9.9%) to 5.2% (FM = 4% [P < .01], IM = 7.9% [P < .01]). For FM, the vitamin D test order rate continued to fall at a 0.08% per week rate after the interventions (end of study: 2.73%). The education intervention showed a relative decrease in each provider type (FM-physician = 16% [P < .

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Effect of Peer Comparison Letters for High-Volume Primary Care Prescribers of Quetiapine in Older and Disabled Adults

Abstract: ClinicalTrials.gov identifier: NCT02467933.

Cited by 89 publications

References 30 publications

A multi‐level strategy for a long lasting reduction in unnecessary laboratory testing: A multicenter before and after study in a teaching hospital network

A multi‐level strategy for a long lasting reduction in unnecessary laboratory testing: A multicenter before and after study in a teaching hospital network

Overuse of early peripheral vascular interventions for claudication

Modifying Provider Vitamin D Screening Behavior in Primary Care

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