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Quality of Care

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Changes in physician behavior are necessary to improve quality of pediatric care

Changing physician behavior to improve quality of pediatric care is the topic of a recent article by Lisa Simpson, M.B., B.Ch., M.P.H., Deputy Director of the Agency for Healthcare Research and Quality, and her colleagues Howard Bauchner, M.D., Child and Adolescent Health Scholar-in-Residence at AHRQ, and John Chessare, M.D., of Boston University School of Medicine. They point out that beyond societal norms, three factors influence physician decisionmaking: physician experience and knowledge, patient characteristics and values (including parent expectations), and external clinical evidence. Depending on the circumstances, one factor may be more influential than another.

Their review of numerous studies on the topic revealed several factors that tend to change physician behavior. Continuing medical education that includes interactive interventions is more effective than passive distribution of information. Practice guideline implementation within an organization can be effective. Clinical paths improve inpatient care. Reminders, both patient and physician, improve quality of preventive health services. Educational outreach is effective, but it is time consuming and expensive. Audit and feedback about physician practices alone are modestly effective.

Financial incentives can change physician behavior under certain circumstances. However, research gaps remain, since few studies considered the context of care delivery in terms of resources available to the practice or the population served.

The researchers conclude that it is critical to continue to measure physician performance in order to change behavior. Changing physician behavior must involve more than one approach. Change often occurs within organizations, and organizational barriers to change must be understood. Approaches to behavioral change should reflect the specific issue and be based on a model of physician decisionmaking. Medical informatics holds great promise, but it has an unclear role in the outpatient setting. Traditional continuing medical education should be changed to include more interactive interventions, conclude the authors.

See "Changing physician behavior," by Drs. Bauchner, Simpson, and Chessare, in the Archives of Disease in Childhood 84, pp. 459-462, 2001.

Reprints (AHRQ Publication No. 01-R067) are available from the AHRQ Publications Clearinghouse.

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