title: Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial.
abstract: BACKGROUND
  Performance feedback and benchmarking, common tools for health care improvement, are rarely studied in randomized trials. Achievable Benchmarks of Care (ABCs) are standards of excellence attained by top performers in a peer group and are easily and reproducibly calculated from existing performance data.
  
  
  OBJECTIVE
  To evaluate the effectiveness of using achievable benchmarks to enhance typical physician performance feedback and improve care.
  
  
  METHODS
  Group-randomized controlled trial conducted in December 1996, with follow-up through 1998.
  
  
  METHODS
  Seventy community physicians and 2978 fee-for-service Medicare patients with diabetes mellitus who were part of the Ambulatory Care Quality Improvement Project in Alabama.
  
  
  METHODS
  Physicians were randomly assigned to receive a multimodal improvement intervention, including chart review and physician-specific feedback (comparison group; n = 35) or an identical intervention plus achievable benchmark feedback (experimental group; n = 35).
  
  
  METHODS
  Preintervention (1994-1995) to postintervention (1997-1998) changes in the proportion of patients receiving influenza vaccination; foot examination; and each of 3 blood tests measuring glucose control, cholesterol level, and triglyceride level, compared between the 2 groups.
  
  
  RESULTS
  The proportion of patients who received influenza vaccine improved from 40% to 58% in the experimental group (P<.001) vs from 40% to 46% in the comparison group (P =.02). Odds ratios (ORs) for patients of achievable benchmark physicians vs comparison physicians who received appropriate care after the intervention, adjusted for preintervention care and nesting of patients within physicians, were 1.57 (95% confidence interval [CI], 1.26-1.96) for influenza vaccination, 1.33 (95% CI, 1.05-1.69) for foot examination, and 1.33 (95% CI, 1.04-1.69) for long-term glucose control measurement. For serum cholesterol and triglycerides, the achievable benchmark effect was statistically significant only after additional adjustment for physician characteristics (OR, 1.40 [95% CI, 1.08-1.82] and OR, 1.40 [95% CI, 1.09-1.79], respectively).
  
  
  CONCLUSIONS
  Use of achievable benchmarks significantly enhances the effectiveness of physician performance feedback in the setting of a multimodal quality improvement intervention.
authors.affiliation: University of Alabama at Birmingham, 1717 11th Ave S, MT 700, Birmingham, AL 35205-4785, USA. ckiefe@uab.edu
authors.forename: C I
authors.initials: CI
authors.lastname: Kiefe
authors.forename: J J
authors.initials: JJ
authors.lastname: Allison
authors.forename: O D
authors.initials: OD
authors.lastname: Williams
authors.forename: S D
authors.initials: SD
authors.lastname: Person
authors.forename: M T
authors.initials: MT
authors.lastname: Weaver
authors.forename: N W
authors.initials: NW
authors.lastname: Weissman
mesh_terms: D000368:Aged; D000407:Alabama; D000553:Ambulatory Care / Q000592:standards*; D019985:Benchmarking; D001786:Blood Glucose; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000628:therapy*; D017719:Diabetic Foot / Q000517:prevention & control; D004502:Education, Medical, Continuing; D018588:Fee-for-Service Plans / Q000592:standards; D005246:Feedback; D006403:Hematologic Tests / Q000706:statistics & numerical data*; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D006278:Medicare / Q000592:standards; D010808:Physical Examination / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017749:Total Quality Management / Q000379:methods; D014280:Triglycerides / Q000097:blood; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose; D007252:Influenza Vaccines; D014280:Triglycerides; D002784:Cholesterol