Effect of linking practice data to published evidence. A randomized controlled trial of clinical direct reports.
OBJECTIVE
The purpose of this study was to evaluate the effect of clinical direct reports (practice data with pertinent evidence from the literature) on dialysis modality selection for patients with end-stage renal disease.


METHODS
A randomized controlled clinical trial was conducted at five dialysis centers. Five of the 10 physician participants were assigned through centralized computerized randomization to the intervention group (who received 12 center-specific clinical direct reports encouraging the consideration of peritoneal dialysis), and five were assigned to the control group, who received usual information but no similar report. One hundred fifty-two patients were eligible for monitoring.


RESULTS
The number of patients allocated to peritoneal dialysis was significantly higher in the intervention group than in the control group (15.3% versus 2.4%; P = 0.044). Due to a need for transient initial hemodialysis by some patients, the percentage of patients receiving peritoneal dialysis further increased through the end of the 3-month follow-up (18.0% versus 4.9%, P = 0.041).


CONCLUSIONS
There were no significant differences between the intervention and control groups in meeting patient preferences, metabolic status, and complication rates. The results of this study show that linking pertinent published evidence to actual practice data can support the implementation of practice recommendations and influence the selection of dialysis treatment for new patients.
Balas
E A
EA
Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia 65211, USA.
Boren
S A
SA
Hicks
L L
LL
Chonko
A M
AM
Stephenson
K
K
D004059:Diffusion of Innovation; D004502:Education, Medical, Continuing / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007255:Information Services; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009398:Nephrology / Q000193:education; D018579:Patient Selection; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*