Project: Research project

Project Details


Compliance with accepted practice guidelines is an important quality issue
in health care and quality management programs often provide feedback
information. However, the use of guidelines to develop quality improvement
programs remains difficult; individual differences in information needs
and appropriate actions are not recognized; and results of the few
clinical trials testing computerized feedback intervention are
controversial. The aim of this project is to assist health care providers in translating
accepted guidelines and practice variation data into measurable individual
quality improvement objectives and to assess the clinical effect of this
intervention on clinical practice patterns in diverse areas of primary
care. In a randomized controlled clinical trial, an individualized quality
feedback intervention will be tested. The feedback will be administered by
a rule-based expert system supporting a) the specification of corporate
and individual quality improvement objectives based on the recommended
guidelines and b) the follow-up of previously set objectives by
highlighting discrepancies between individual objectives and actual-
practice patterns. The sites of the trial will be the outpatient centers
of Humana Health Care Plans, a health maintenance organization in Kansas
City. The new individualized quality feedback method will be used to
implement various guidelines distributed by AHCPR (HIV positive
asymptomatic patients, depressed outpatients) and developed by Humana
(antibiotic prescription, management of diabetes requiring medication).
Forty three physicians and 13 nurse practitioners will be randomly
assigned to participate in the new quality management program or to
receive usual feedback information on quality. Balanced stratification
will occur by provider site. Patients will be followed up six months after
their first visit which makes them eligible for the care recommended by
the guidelines. Observed major variables will include the number of
identified eligible visits, frequency of recommended procedures ordered
during eligible visits, specialist referrals, and use of not recommended
procedures. A sample size of the eligible patients is estimated to be
adequate to test the primary hypothesis. The new quality management
intervention and the results of our controlled trial should have practical
applicability in a wide variety of actively managed health care
organizations (e.g., HMO, PPO, IPA).
Effective start/end date1/1/9412/31/95


  • National Institutes of Health
  • National Institutes of Health


  • Medicine(all)


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