title: Improving Clinical Practice Using a Novel Engagement Approach: Measurement, Benchmarking and Feedback, A Longitudinal Study.
abstract: BACKGROUND
  Poor clinical outcomes are caused by multiple factors such as disease progression, patient behavior, and structural elements of care. One other important factor that affects outcome is the quality of care delivered by a provider at the bedside. Guidelines and pathways have been developed with the promise of advancing evidence-based practice. Yet, these alone have shown mixed results or fallen short in increasing adherence to quality of care. Thus, effective, novel tools are required for sustainable practice change and raising the quality of care.
  
  
  METHODS
  The study focused on benchmarking and measuring variation and improving care quality for common types of breast cancer at four sites across the United States, using a set of 12 Clinical Performance and Value(®) (CPV(®)) vignettes per site. The vignettes simulated online cases that replicate a typical visit by a patient as the tool to engage breast cancer providers and to identify and assess variation in adherence to evidence-based practice guidelines and pathways.
  
  
  RESULTS
  Following multiple rounds of CPV measurement, benchmarking and feedback, we found that scores had increased significantly between the baseline round and the final round (P < 0.001) overall and for all domains. By round 4 of the study, the overall score increased by 14% (P < 0.001), and the diagnosis with treatment plan domain had an increase of 12% (P < 0.001) versus baseline.
  
  
  CONCLUSIONS
  We found that serially engaging breast cancer providers with a validated clinical practice engagement and measurement tool, the CPVs, markedly increased quality scores and adherence to clinical guidelines in the simulated patients. CPVs were able to measure differences in clinical skill improvement and detect how fast improvements were made.
authors.affiliation: QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA; University of California, San Francisco and Los Angeles, CA, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Peabody
authors.affiliation: QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Paculdo
authors.affiliation: QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Tamondong-Lachica
authors.affiliation: QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA.
authors.forename: Jhiedon
authors.initials: J
authors.lastname: Florentino
authors.affiliation: QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA.
authors.forename: Othman
authors.initials: O
authors.lastname: Ouenes
authors.affiliation: QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA.
authors.forename: Riti
authors.initials: R
authors.lastname: Shimkhada
authors.affiliation: QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: DeMaria
authors.affiliation: QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA.
authors.forename: Trever B
authors.initials: TB
authors.lastname: Burgon
keywords: Clinical oncology; Evidence-based medicine; Medical education; Patient vignettes; Quality of care; Simulated patients