title: The small group consensus process for changing physician practices: influenza vaccination.
abstract: OBJECTIVE
  To evaluate the effectiveness of a small group consensus process in enhancing compliance with guidelines for influenza vaccination among older HMO members.
  
  
  METHODS
  A controlled study of the practice of primary care physicians, with pre/post comparisons and a 2-year follow-up.
  
  
  METHODS
  An 84,000 member prepaid staff model HMO group practice.
  
  
  METHODS
  Primary care clinicians (N = 36) practicing in a staff model HMO.
  
  
  METHODS
  A small-group process, including opinion leader, feedback, and group decision making.
  
  
  METHODS
  Percentage of patients in a given physician-panel who received influenza immunization.
  
  
  RESULTS
  Improvement in vaccination rate from 60.8% to 72.35% (with further increases over 2 successive years), in the intervention group as compared with improvement in the control from 60.7% to 65.93%.
  
  
  CONCLUSIONS
  In this model, the small group consensus process resulted in an alteration in physician practice pattern, yielding a significant improvement in immunization rates above the already-established level of 60%.
authors.affiliation: Health Care Plan, Buffalo, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Calkins
authors.forename: L A
authors.initials: LA
authors.lastname: Katz
authors.forename: J
authors.initials: J
authors.lastname: Karuza
authors.forename: A
authors.initials: A
authors.lastname: Wagner
mesh_terms: D000368:Aged; D003245:Consensus Statements as Topic; D003659:Decision Making, Organizational; D006279:Health Maintenance Organizations / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control; D017146:Models, Organizational; D009518:New York; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'