Institutional Peer Review Can Reduce the Risk and Cost of Carotid Endarterectomy

Olcott, Cornelius; Mitchell, R. Scott; Steinberg, Gary K.; Zarins, Christopher K.

doi:10.1001/archsurg.135.8.939

Cited by 22 publications

(23 citation statements)

References 20 publications

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“…Reduction of complications postprocedure intuitively provides benefits in terms of patient outcomes, but has also been shown previously with open carotid surgery to lower hospital costs. 11 What remains in question is the long-term significance of DW-MRI detected microemboli.…”

Section: Discussionmentioning

confidence: 99%

Reduction of postprocedure microemboli following retrospective quality assessment and practice improvement measures for carotid angioplasty and stenting

Tedesco

Dalman

Wei

et al. 2009

Journal of Vascular Surgery

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Despite successful performance of 47 consecutive CAS procedures without permanent neurologic sequelae, significant reductions in periprocedural embolic events as identified via DW-MRI lesions may be achieved through implementation of quality improvement measures identified through continuous outcome analysis. The long-term neurologic benefits associated with reduced subclinical neurologic events remains to be determined.

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Section: Discussionmentioning

confidence: 99%

Reduction of postprocedure microemboli following retrospective quality assessment and practice improvement measures for carotid angioplasty and stenting

Tedesco

Dalman

Wei

et al. 2009

Journal of Vascular Surgery

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“…This takes the form of a graph showing the proportion of patients per GP who meet guidelines for test frequency and management (meeting HbA1c targets). Comparative feedback has been shown to be an effective mean of changing surgeons’ behaviour [25, 26]. Both forms of feedback were derived from de-identified data provided by local pathology laboratories…”

Section: Methodsmentioning

confidence: 99%

Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners

Paul

Piterman

Shaw

et al. 2017

Trials

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BackgroundIn Australia, rural and remote communities have high rates of diabetes-related death and hospitalisation. General practitioners (GPs) play a major role in diabetes detection and management. Education of GPs could optimise diabetes management and improve patient outcomes at a population level. The study aimed to describe the uptake of a continuing medical education intervention for rural GPs and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control.MethodTrial design: the cluster randomised controlled trial involved towns as the unit of allocation and analysis with outcomes assessed by de-identified pathology data (not reported here). The intervention programme consisted of an online active learning module, direct electronic access to specialist advice and performance feedback. Multiple rounds of invitation were used to engage GPs with the online intervention content. Evidence-based strategies (e.g. pre-notification, rewards, incentives) were incorporated into the invitations to enrol in the programme. Recruitment to the programme was electronically monitored through the hosting software package during the study intervention period.ResultsEleven matched pairs of towns were included in the study. There were 146 GPs in the 11 intervention towns, of whom 34 (23.3%) enrolled in the programme, and 8 (5.5%) completed the online learning module. No town had more than 10% of the resident GPs complete the learning module. There were no contacts made by GPs regarding requests for specialist advice. Consequently, the trial was discontinued.ConclusionThere is an ongoing need to engage primary care physicians in improving diabetes monitoring and management in rural areas. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake, even when evidence-based recruitment strategies are implemented.Trial registrationAustralian New Zealand Clinical Trials Registry, identifier: ACTRN12611000553976. Retrospectively registered on 31 May 2011.

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“…This takes the form of a graph showing the proportion of patients per GP who meet guidelines for test frequency and management (meeting HbA1c targets). Comparative feedback has been shown to be an effective means of changing surgeons’ behavior [33,34]. Both forms of feedback were derived from de-identified data provided by local pathology laboratories.…”

Section: Method/designmentioning

confidence: 99%

Diabetes in rural towns: effectiveness of continuing education and feedback for healthcare providers in altering diabetes outcomes at a population level: protocol for a cluster randomised controlled trial

et al. 2013

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BackgroundType 2 diabetes is one of the fastest growing chronic diseases internationally. The health complications associated with type 2 diabetes can be prevented, delayed, or improved via early diagnosis and effective management. This research aims to examine the impact of a primarily web-based educational intervention on the diabetes care provided by general practitioners (GPs) in rural areas, and subsequent patient outcomes. A population-level approach to outcome assessment is used, via whole-town de-identified pathology records.Methods/designThe study uses a cluster randomised controlled trial with rural communities as the unit of analysis. Towns from four Australian states were selected and matched on factors including rurality, population size, proportion of the population who were Indigenous Australians, and socio-economic status. Eleven pairs of towns from two states were suitable for the trial, and one town from each pair was randomised to the experimental group. GPs in the towns allocated to the experimental group are offered an intervention package comprising education on best practice diabetes care via an on-line active learning module, a moderated discussion forum, access to targeted and specialist advice through an on-line request form, and town-based performance feedback on diabetes monitoring and outcomes. The package is offered via repeated direct mail.DiscussionThe benefits of the outcomes of the trial are described along with the challenges and limitations associated with the methodology.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12611000553976

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Institutional Peer Review Can Reduce the Risk and Cost of Carotid Endarterectomy

Abstract: Hypothesis: Surgeon-directed institutional peer review, associated with positive physician feedback, can decrease the morbidity and mortality rates associated with carotid endarterectomy.Design: Case series.Setting: Tertiary care university teaching hospital.

Cited by 22 publications

References 20 publications

Reduction of postprocedure microemboli following retrospective quality assessment and practice improvement measures for carotid angioplasty and stenting

Reduction of postprocedure microemboli following retrospective quality assessment and practice improvement measures for carotid angioplasty and stenting

Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners

Diabetes in rural towns: effectiveness of continuing education and feedback for healthcare providers in altering diabetes outcomes at a population level: protocol for a cluster randomised controlled trial

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