title: Changing physician practice behavior to measure and improve clinical outcomes.
abstract: Physician practice behavior often produces poor clinical outcomes in the management of cardiovascular disease risk factors in spite of effective treatments and guidelines. The behavior of 165 physicians in 2 settings (suburban and urban) was studied. After collecting baseline clinical data, including systolic blood pressure and low-density lipoprotein cholesterol, a series of interventions was conducted, including academic detailing. Low-density lipoprotein cholesterol decreased 10.4% in suburban patients with cardiovascular disease in the intervention group (P = .001) and 10.5% in the enhanced intervention group (P = .001). Systolic blood pressure decreased 1.11% (P = .357) in the intervention group and 5.13% in the enhanced intervention group (P < .001). In urban hypertensive patients, systolic blood pressure decreased 5.03% (P = .001) and low-density lipoprotein cholesterol decreased 7.01% (P < .001). Combining urban and suburban data, low-density lipoprotein cholesterol decreased 9.32% (P < .001) and systolic blood pressure decreased 4.00% (P < .001). Providing physicians with their clinical outcomes, reviewing national guidelines, and setting expectations, associated with modest practice systems innovations, can produce significant measurable clinical improvements.
authors.affiliation: Center for Global Health Systems, Management, and Policy, Wright State University Boonshoft School of Medicine, Kettering, Ohio 45420, USA. richard.schuster@wright.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schuster
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Terwoord
authors.forename: Joseph
authors.initials: J
authors.lastname: Tasosa
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008074:Lipoproteins / Q000097:blood; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D013383:Suburban Population; D014505:Urban Population
chemical_list: D008074:Lipoproteins