Comparison of an enhanced versus a written feedback model on the management of Medicare inpatients with venous thrombosis.
BACKGROUND
A multistate randomized study conducted under the Health Care Financing Administration's (HCFA's) Health Care Quality Improvement Program (HCQIP) offered the opportunity to compare the effect of a written feedback intervention (WFI) with that of an enhanced feedback intervention (EFI) on improving the anticoagulant management of Medicare beneficiaries who present to the hospital with venous thromboembolic disease.


METHODS
Twenty-nine hospitals in five states were randomly assigned to receive written hospital-specific feedback (WFI) of feedback enhanced by the participation of a trained physician, quality improvement tools, and an Anticoagulant Management of Venous Thrombosis (AMVT) project liaison (EFI). Differences in the performance of five quality indicators between baseline and remeasurement were assessed. Quality managers were interviewed to determine perceptions of project implementation.


RESULTS
No significant differences in the change from baseline to remeasurement were found between the two intervention groups. Significant improvement in one indicator and significant decline in two indicators were found for one or both groups. Yet 59% of all quality managers perceived the AMVT project as being successful to very successful, and more EFI quality managers perceived success than did WFI managers (71% versus 40%). In the majority of EFI hospitals, physician liaisons played an important role in project implementation.


CONCLUSIONS
Study results indicated that the addition of a physician liaison, quality improvement tools, and a project liaison did not provide incremental value to hospital-specific feedback for improving quality of care. Future studies with larger sample sizes, lengthier follow-up periods, and interventions that include more of the elements shown to affect practice behavior change are needed to identify an optimal feedback model for use by external quality management organizations.
Hayes
R
R
Kerr L. White Institute for Health Services Research, USA. hayes_clarice@lilly.com
Bratzler
D
D
Armour
B
B
Moore
L
L
Murray
C
C
Stevens
B R
BR
Radford
M
M
Fitzgerald
D
D
Elward
K
K
Ballard
D J
DJ
D000368:Aged; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007721:Knowledge of Results, Psychological; D008297:Male; D006278:Medicare / Q000592:standards*; D017146:Models, Organizational; D008486:Physician Executives; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D015912:Thrombolytic Therapy / Q000592:standards*; D014481:United States; D020246:Venous Thrombosis / Q000188:drug therapy*