Abstract
BackgroundThe impact of the Choosing Wisely (CW) campaign is debated as recommendations alone may not modify physician behavior.ObjectiveThe aim of this study was to assess whether behavioral interventions with physician assessment and feedback during quality circles (QCs) could reduce low-value services.Design and ParticipantsPre-post quality improvement intervention with a parallel comparison group involving outpatients followed in a Swiss-managed care network, including 700 general physicians (GPs) and 150,000 adult patients.InterventionsInterventions included performance feedback about low-value activities and comparison with peers during QCs. We assessed individual physician behavior and healthcare use from laboratory and insurance claims files between August 1, 2016, and October 31, 2018.Main MeasuresMain outcomes were the change in prescription of three low-value services 6 months before and 6 months after each intervention: measurement of prostate-specific antigen (PSA) and prescription rates of proton pump inhibitors (PPIs) and statins.Key ResultsAmong primary care practices, a QC intervention with physician feedback and peer comparison resulted in lower rates of PPI prescription (pre-post mean prescriptions per GP 25.5 ± 23.7 vs 22.9 ± 21.4, p value<0.01; coefficient of variation (Cov) 93.0% vs 91.0%, p=0.49), PSA measurement (6.5 ± 8.7 vs 5.3 ± 6.9 tests per GP, p<0.01; Cov 133.5% vs 130.7%, p=0.84), as well as statins (6.1 ± 6.8 vs 5.6 ± 5.4 prescriptions per GP, p<0.01; Cov 111.5% vs 96.4%, p=0.21). Changes in prescription of low-value services among GPs who did not attend QCs were not statistically significant over this time period.ConclusionOur results demonstrate a modest but statistically significant effect of QCs with educative feedback in reducing low-value services in outpatients with low impact on coefficient of variation. Limiting overuse in medicine is very challenging and dedicated discussion and real-time review of actionable data may help.
Highlights
Quality circles (QCs) are small groups of general physicians (GPs), typically one moderator and five to ten participants from similar backgrounds, who meet at regular intervals to discuss and review their clinical practice and solve qualityoriented medical problems
We focused on treatments and procedures that are frequently overused, feasible to change, and in the domain of the Swiss Choosing Wisely (CW) campaign[3]
Our results suggest that among primary care practices, thematic quality circles (QCs) intervention with data feedback and peer comparison resulted in lower mean of pump inhibitors (PPIs) prescription (25.5 ± 23.7 per GP vs 22.9 ± 21.4 per GP, p
Summary
Quality circles (QCs) are small groups of general physicians (GPs), typically one moderator and five to ten participants from similar backgrounds, who meet at regular intervals to discuss and review their clinical practice and solve qualityoriented medical problems. DESIGN AND PARTICIPANTS: Pre-post quality improvement intervention with a parallel comparison group involving outpatients followed in a Swiss-managed care network, including 700 general physicians (GPs) and 150,000 adult patients. KEY RESULTS: Among primary care practices, a QC intervention with physician feedback and peer comparison resulted in lower rates of PPI prescription (pre-post mean prescriptions per GP 25.5 ± 23.7 vs 22.9 ± 21.4, p value
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
