Changing physician practice behavior to measure and improve clinical outcomes.
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.
Schuster
Richard J
RJ
Center for Global Health Systems, Management, and Policy, Wright State University Boonshoft School of Medicine, Kettering, Ohio 45420, USA. richard.schuster@wright.edu
Terwoord
Nancy A
NA
Tasosa
Joseph
J
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
D008074:Lipoproteins