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Delayed Feedback of Physician Performance Versus Immediate Reminders to Perform Preventive Care: Effects on Physician Compliance
Abstract
In an academic general medicine clinic, we performed a randomized, controlled trial to compare (1) the effects of supplying monthly feedback reports of compliance with preventive care protocols by 135 internal medicine house staff with (2) the effects of specific reminders given to them at the time of patient visits. The protocols were randomly divided into two groups, A and B, and half the house staff were given feedback for Group A and half for Group B. Thus, each group served as a control for the other. Each feedback group was also randomly assigned to receive reminders for either Group A or B protocols. House staff receiving feedback more often complied with fecal occult blood testing, mammography, pneumococcal vaccination, use of metronidazole, and combined Group A and B protocols than did controls (P less than 0.01). There was also significantly more compliance with the same protocols by house staff receiving reminders, but the increase for fecal occult blood testing, pneumococcal vaccination, and combined Group A protocols was twice that seen in physicians given feedback alone. In addition, reminders alone increased compliance with oral calcium supplementation. Overall compliance with the preventive care protocols was low: 10-15% in physicians receiving neither feedback nor reminders, increasing to 15-30% in those receiving reminders. Physician compliance with suggested preventive care protocols can be increased by both delayed feedback and immediate reminders, but reminders have a greater effect.
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“Tierney 1986 in a complex factorial trial with active controls found that reminders together with audit and feedback were more effective than feedback alone for provision of preventive services by internal medicine trainees (unadjusted RD = 8.0%; no P value reported).”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Tierney 1986
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Metadata
- Authors
- Tierney, W. M., Hui, S. L., & McDonald, C. J.
- Affiliations
- Regenstrief Institute (US)
- Corresponding author
- Tierney, William M.
- McDonald, Clement J.
- Venue
- Medical Care
- Published
- 1986-08
- Volume
- 24
- Issue
- 8
- Pages
- 659-666
- ISSN
- 0025-7079 (ISSN-L)
- OpenAlex
- W2006363447
- Cited by
- 337
- References
- 19
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 1 · 2022: 2 · 2020: 6 · 2019: 1 · 2018: 4 · 2017: 3 · 2016: 4 · 2015: 6 · 2014: 3 · 2013: 6 · 2012: 5
- FWCI
- 31.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (HS-04080, HS-04996)
- Topics
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- preventive medicine, physician performance feedback, clinical reminders, fecal occult blood test, mammography, pneumococcal vaccination, metronidazole, oral calcium supplementation, quality improvement
- MeSH terms
- Clinical Competence, Computers, Feedback, Hospitals, General, Humans, Indiana, Medical Staff, Hospital, Outpatient Clinics, Hospital, Preventive Health Services, Random Allocation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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