title: Changing doctors' behaviours: an educational program to disseminate a new clinical pathway for the hospital management of hip fractures in elderly patients in the Lazio Region, Italy.
abstract: OBJECTIVE
  Concerns with patient safety have increased interest in approaches to improving doctors' performance, yet dissemination of clinical guidelines and conventional continuing medical education have often failed. This study investigated the effects of an educational program based on reflection upon experience on the quality of care for patients with hip fracture in Lazio, Italy.
  
  
  METHODS
  Five hospitals participated. The study consisted of the development of a clinical pathway, a preparatory phase and the educational intervention itself, which comprised a course followed by monthly audits with reflection on practice, guided by analysis of patients' charts. Data on the quality of care for patients with hip fracture were collected from the routine information system for the period before and after the intervention.
  
  
  RESULTS
  There was a significant increase in the proportion of patients who underwent surgery within 48 hours of admission (from 7% in 2006 to 26.4% in 2007) and a significant reduction in the average length of hospital stay (from 18.8 to 16.4 days). Some process indicators of quality of care were high after the intervention, though non-recommended practices were still routinely used (e.g. urinary catheterization in 72.2% of patients). There were differences in the changes when comparing hospitals.
  
  
  CONCLUSIONS
  An educational intervention that combined the dissemination of a clinical pathway with external auditing geared to reflection upon practice was effective in promoting changes in doctors' behaviours. The persistence of non-recommended practices and the variation among hospitals indicate that multiple factors influence performance and affect the effectiveness of interventions.
authors.affiliation: Azienda Sanitaria Locale Roma C, Rome, Italy.
authors.forename: Alma
authors.initials: A
authors.lastname: Ciaschi
authors.forename: Andrea
authors.initials: A
authors.lastname: Caprara
authors.forename: Francesca
authors.initials: F
authors.lastname: Gillespie
authors.forename: Giacomo
authors.initials: G
authors.lastname: Furnari
authors.forename: Sílvia
authors.initials: S
authors.lastname: Mamede
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D004059:Diffusion of Innovation; D004502:Education, Medical, Continuing; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007558:Italy; D008875:Middle Aged; D010820:Physicians; D010865:Pilot Projects