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Effect of Peer Benchmarking on Specialist Electronic Consult Performance in a Los Angeles Safety-Net: a Cluster Randomized Trial.
Meeker, Daniella; Friedberg, Mark W; Knight, Tara K; Doctor, Jason N; Zein, Dina; Cayasso-McIntosh, Nancy; Goldstein, Noah J; Fox, Craig R; Linder, Jeffrey A; Persell, Stephen D; Dea, Stanley; Giboney, Paul; Yee, Hal F.
  • Meeker D; Department of Population and Public Health Sciences, University of Southern California, 2250 Alcazar St, Los Angeles, CA, 90033, USA. dmeeker@usc.edu.
  • Friedberg MW; Brigham and Women's Hospital, Boston, MA, USA.
  • Knight TK; Blue Cross Blue Shield of Massachusetts, Boston, MA, USA.
  • Doctor JN; Sol Price School of Public Policy & Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA.
  • Zein D; Sol Price School of Public Policy & Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA.
  • Cayasso-McIntosh N; Department of Population and Public Health Sciences, University of Southern California, 2250 Alcazar St, Los Angeles, CA, 90033, USA.
  • Goldstein NJ; Los Angeles County Department of Health Services, Los Angeles, CA, USA.
  • Fox CR; Anderson School of Management, University of California, Los Angeles, Los Angeles, USA.
  • Linder JA; Anderson School of Management, University of California, Los Angeles, Los Angeles, USA.
  • Persell SD; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
  • Dea S; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
  • Giboney P; Los Angeles County Department of Health Services, Los Angeles, CA, USA.
  • Yee HF; Los Angeles County Department of Health Services, Los Angeles, CA, USA.
J Gen Intern Med ; 37(6): 1400-1407, 2022 05.
Article in English | MEDLINE | ID: covidwho-1401076
ABSTRACT

BACKGROUND:

Since the advent of COVID-19, accelerated adoption of systems that reduce face-to-face encounters has outpaced training and best practices. Electronic consultations (eConsults), structured communications between PCPs and specialists regarding a case, have been effective in reducing face-to-face specialist encounters. As the health system rapidly adapts to multiple new practices and communication tools, new mechanisms to measure and improve performance in this context are needed.

OBJECTIVE:

To test whether feedback comparing physicians to top performing peers using co-specialists' ratings improves performance.

DESIGN:

Cluster-randomized controlled trial

PARTICIPANTS:

Eighty facility-specialty clusters and 214 clinicians INTERVENTION Providers in the feedback arms were sent messages that announced their membership in an elite group of "Top Performers" or provided actionable recommendations with feedback for providers that were "Not Top Performers." MAIN

MEASURES:

The primary outcomes were changes in peer ratings in the following performance dimensions after feedback was received (1) elicitation of information from primary care practitioners; (2) adherence to institutional clinical guidelines; (3) agreement with peer's medical decision-making; (4) educational value; (5) relationship building. KEY

RESULTS:

Specialists showed significant improvements on 3 of the 5 consultation performance dimensions medical decision-making (odds ratio 1.52, 95% confidence interval 1.08-2.14, p<.05), educational value (1.86, 1.17-2.96) and relationship building (1.63, 1.13-2.35) (both p<.01).

CONCLUSIONS:

The pandemic has shed light on clinicians' commitment to professionalism and service as we rapidly adapt to changing paradigms. Interventions that appeal to professional norms can help improve the efficacy of new systems of practice. We show that specialists' performance can be measured and improved with feedback using aspirational norms. TRIAL REGISTRATION clinicaltrials.gov NCT03784950.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Benchmarking / COVID-19 Type of study: Controlled clinical trial / Clinical Practice Guide / Prognostic study / Randomized controlled trials Limits: Humans Country/Region as subject: North America Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2022 Document Type: Article Affiliation country: S11606-021-07002-1

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Benchmarking / COVID-19 Type of study: Controlled clinical trial / Clinical Practice Guide / Prognostic study / Randomized controlled trials Limits: Humans Country/Region as subject: North America Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2022 Document Type: Article Affiliation country: S11606-021-07002-1