title: Do local opinion leaders augment hospital quality improvement efforts? A randomized trial to promote adherence to unstable angina guidelines.
abstract: BACKGROUND
  The influence of an opinion leader intervention on adherence to Unstable Angina (UA) guidelines compared with a traditional quality improvement model was investigated.
  
  
  METHODS
  A group-randomized controlled trial with 2210 patients from 21 hospitals was designed. There were three intervention arms: (1) no intervention (NI); (2) a traditional Health Care Quality Improvement Program (HCQIP); and (3) a physician opinion leader in addition to the HCQIP model (OL). Quality indicators included: electrocardiogram within 20 minutes, antiplatelet therapy within 24 hours and at discharge, and heparin and beta-blockers during hospitalization. Hospitals could determine the specific indicators they wished to target. Potential cases of UA were identified from Medicare claims data. UA confirmation was determined by a clinical algorithm based on data abstracted from medical records. Data analyses included both hospital level analysis (analysis of variance) and patient level analysis (generalized linear models).
  
  
  RESULTS
  The only statistically significant postintervention difference in percentage compliant was greater improvement for the OL group in the use of antiplatelet therapy at 24 hours in both hospital level (P = 0.01) and patient level analyses (P <0.05) compared with the HCQIP and NI groups. When analyses were confined to hospitals that targeted specific indicators, compared with the HCQIP hospitals, the OL hospitals showed significantly greater change in percentage compliant postintervention in both antiplatelet therapy during the first 24 hours (20.2% vs. -3.9%, P = 0.02) and heparin (31.0% vs.9.1%, P = 0.05).
  
  
  CONCLUSIONS
  The influence of physician opinion leaders was unequivocally positive for only one of five quality indicators. To maximize adherence to best practices through physician opinion leaders, more research on how these physicians influence health care delivery in their organizations will be required.
authors.affiliation: Center for Outcomes and Effectiveness Research and Education, School of Health Related Professions, University of Alabama at Birmingham, 35294, USA. eberner@uab.edu
authors.forename: Eta S
authors.initials: ES
authors.lastname: Berner
authors.forename: C Suzanne
authors.initials: CS
authors.lastname: Baker
authors.forename: Ellen
authors.initials: E
authors.lastname: Funkhouser
authors.forename: Gustavo R
authors.initials: GR
authors.lastname: Heudebert
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
authors.forename: Crayton A
authors.initials: CA
authors.lastname: Fargason
authors.forename: Qing
authors.initials: Q
authors.lastname: Li
authors.forename: Sharina D
authors.initials: SD
authors.lastname: Person
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
mesh_terms: D000368:Aged; D000407:Alabama; D000465:Algorithms; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D001291:Attitude of Health Personnel; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006302:Health Services Research; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007857:Leadership; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000592:standards*; D016344:Medicare Part A; D017146:Models, Organizational; D018024:Peer Review, Health Care; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D011859:Radiography; D017749:Total Quality Management / Q000458:organization & administration*