Changing clinical practice. Prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism
Abstract
OBJECTIVE: To determine the effect of continuing medical education (CME) with and without a quality assurance component (CME+QA) on physician practices in the prevention of venous thromboembolism. METHODS: A communitywide study was performed in 15 short-stay hospitals in central Massachusetts. The study population included 3158 patients in acute-care hospitals with multiple risk factors for venous thromboembolism. Study hospitals were randomly assigned to one of two educational strategies or to a control group that received no intervention. RESULTS: The proportion of patients at high risk for venous thromboembolism who received effective methods of prophylaxis increased significantly from 29% in 1986 to 52% in 1989 (P < .001). This increase was seen in all study groups: control hospitals, 40% to 51% (P < .001); CME hospitals, 21% to 49% (P < .0001); and CME+QA hospitals, 27% to 55% (P < .0001). The increase in prophylaxis use from 1986 to 1989 was significantly greater among patients cared for in hospitals whose physicians participated in a formal CME program (an increase of 28%) than in control hospitals (an increase of 11%) (P < .001). There was no significant difference in the use of prophylaxis in hospitals whose physicians received CME+QA interventions compared with hospitals whose physicians received CME interventions alone (identical increases of 28%). CONCLUSION: A formal CME program significantly increased the frequency with which physicians prescribed prophylaxis for venous thromboembolism. We believe the key factor in our CME interventions that motivated clinicians to change their practices was the provision of hospital-specific data demonstrating a compelling need for improvement. Despite the substantial investment by hospitals in QA, traditional QA intervention appeared to provide no additional benefit. Even after extensive CME/QA interventions, prophylaxis for venous thromboembolism remained underutilized, suggesting the need to develop new approaches to changing clinical practice.
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Anderson 1994 found little or no difference in prophylaxis of venous thromboembolism when comparing feedback given to large groups as part of a CME program with and without sending individualised feedback reports to participants (adjusted RD = 0%; no P value reported).
“Finally, Anderson 1994 found little or no difference when they compared feedback given to large groups as part of a CME (continuing medical education) program, with and without sending individualised feedback reports to participants for prophylaxis of venous thromboembolism (adjusted RD = 0%; no P value reported for this comparison).”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Anderson 1994
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Audit and feedback: effects on professional practice and healthcare outcomes
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., O'Brien, M. A., Johansen, M., Grimshaw, J., & Oxman, A. D. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub3 · Cited by 5,485 · see citing works
Audit and feedback: effects on professional practice and health care outcomes
Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O'Brien, M. A., & Oxman, A. D. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub2 · Cited by 912 · see citing works
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Sauaia, A., Ralston, D., Schluter, W. W., Marciniak, T. A., Havranek, E. P., & Dunn, T. R. (2000) · American Journal of Medical Quality · doi:10.1177/106286060001500503 · Cited by 24 · see citing works
- Authors
- Anderson, F. A.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- Corresponding author
- Anderson, Frederick A.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1994-03-28
- Volume
- 154
- Issue
- 6
- Pages
- 669
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2034483395
- Cited by
- 156
- References
- 23
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 3 · 2019: 2 · 2018: 3 · 2017: 1 · 2016: 3 · 2015: 3 · 2014: 3 · 2013: 5 · 2012: 5
- FWCI
- 7.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01hl035862-04)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- continuing medical education, quality assurance, venous thromboembolism, thromboprophylaxis, physician practice change, hospital-acquired thrombosis, short-stay hospitals
- MeSH terms
- Aged, Education, Medical, Continuing, Female, Humans, Male, Massachusetts, Medical Staff, Hospital, Practice Patterns, Physicians', Prospective Studies, Quality Assurance, Health Care, Thromboembolism, United States, Multivariate Analysis, Odds Ratio
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