title: Can didactic continuing education improve clinical decision making and reduce cost of quality? Evidence from a case study.
abstract: BACKGROUND
  Administration of human serum albumin (HSA) solutions for the resuscitation of critically ill patients remains controversial. The objective of this study was to assess the effect of continuing medical education (CME) on health care professionals' clinical decision making with regard to HSA administration and the costs of quality (COQ). A quasi-experimental study of time series association of CME intervention with COQ and use of HSA solution was conducted at the Surgery Department of the Hospital Valjevo, Serbia. The CME contained evidence-based criteria for HSA solution administration in surgical patients. The preintervention period was defined as January 2009 to May 2011. CME was provided in June 2011, with the postintervention period June 2011 to May 2012.
  
  
  METHODS
  Total mortality rate, the rate of nonsurgical mortality, the rate of surgical mortality, the rate of sepsis patient mortality, index of irrational use of HSA solutions, and number of hospital days per hospitalized patient were collected for each month as quality indicators. Statistical analysis was performed by multivariate autoregressive integrated moving average (MARIMA) modeling. The specification of the COQ was performed according to a traditional COQ model.
  
  
  RESULTS
  The CME intervention resulted in an average monthly reduction of the hospital days per hospitalized patient, the rate of sepsis patient mortality, index of irrational use of HSA solutions, and COQ for $593,890.77 per year.
  
  
  CONCLUSIONS
  Didactic CME presenting evidence-based criteria for HSA administration was associated with improvements in clinical decisions and COQ. In addition, this study demonstrates that models combining MARIMA and traditional COQ models can be useful in the evaluation of CME interventions aimed at reducing COQ.
authors.forename: Mira
authors.initials: M
authors.lastname: Vuković
authors.forename: Branislav S
authors.initials: BS
authors.lastname: Gvozdenović
authors.forename: Milena
authors.initials: M
authors.lastname: Ranković
authors.forename: Bryan P
authors.initials: BP
authors.lastname: McCormick
authors.forename: Danica D
authors.initials: DD
authors.lastname: Vuković
authors.forename: Biljana D
authors.initials: BD
authors.lastname: Gvozdenović
authors.forename: Dragana A
authors.initials: DA
authors.lastname: Kastratović
authors.forename: Srdjan Z
authors.initials: SZ
authors.lastname: Marković
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ilić
authors.forename: Mihajlo B
authors.initials: MB
authors.lastname: Jakovljević
mesh_terms: D000066491:Clinical Decision-Making; D017046:Cost Savings; D016638:Critical Illness; D004502:Education, Medical, Continuing; D019317:Evidence-Based Medicine; D006801:Humans; D008505:Medical Staff, Hospital / Q000193:education; D058996:Quality Improvement / Q000191:economics; D011787:Quality of Health Care / Q000191:economics*; D012151:Resuscitation / Q000379:methods; D055771:Serbia; D012709:Serum Albumin / Q000008:administration & dosage; D013503:Surgery Department, Hospital
chemical_list: D012709:Serum Albumin
keywords: cost of quality; cost/benefit-cost/effectiveness analysis; human serum albumin; innovative educational interventions; mortality; quality improvement/Six Sigma/TQM; quality indicators; surgery department