1. 1 How to Change Practice Patterns? Farrokh Alemi, Ph.D.

2. 2 Performance Evaluation Advances in measurement – of severity –of health status –of patient satisfaction have led to evaluation of performance of clinicians. Is this reasonable?

3. Farrokh Alemi, Ph.D. 3 What Profiling does? Identify and characterize differences in practice style Provide benchmarks Not fail proof

4. Farrokh Alemi, Ph.D. 4 Six Steps to Implementation Step 1. Getting StartedStep 1. Getting Started. Step 2. Collecting and Analyzing DataStep 2. Collecting and Analyzing Data. Step 3. Presenting the InformationStep 3. Presenting the Information. Step 4. Disseminating InformationStep 4. Disseminating Information. Step 5. Supporting ConsumersStep 5. Supporting Consumers. Step 6. Evaluating the ProjectStep 6. Evaluating the Project.

5. Farrokh Alemi, Ph.D. 5 Five Key Points About Presenting There is no one way to do this—but there are better ways and worse ways. The answer that's best for you depends on who your audience is and how they'll use the information. Data cannot be presented in a vacuum. For the typical consumer, a quality measure has no meaning on its own. The medium shapes the message.

6. Farrokh Alemi, Ph.D. 6 Test It Before Presenting It Can they read the information easily. Can they understand it. Is the content appropriate for your audience. Is the audience interested in your content. Can they use your materials for the purpose for which they are intended. Can navigate they through the materials to find the information they want

7. Farrokh Alemi, Ph.D. 7 Distributing Information Release information early enough so that the audience can review it ahead of time Choose a medium that enhances the message Understand that information has a life of its own –Provide support for interpretation of information –Indicate limitations

8. Farrokh Alemi, Ph.D. 8 Before the feedback session Schedule a feedback time and date as soon as possible. Enter your organization code and receive your automated feedback report. Check your data against the report, make sure that there are no mistakes in the report you are providing the sponsor. Check for grammar and spelling. Check that the average across the various reports are calculated accurately. Data entry errors occur quite often. Prepare handouts for discussion during the session.

9. Farrokh Alemi, Ph.D. 9 At the meeting Make it clear that the evaluation is confidential. Go through introductions. Acknowledge the limitation of the study. Present the data and not your conclusions. Explicitly ask for their evaluation of the data after each section of the report is presented. Allow the sponsor to talk about the data. DO NOT defend your report. Thank the sponsor for their time and effort

10. Farrokh Alemi, Ph.D. 10 After the meeting As a group, send a report to your instructor. 1.What have you learn regarding data collection effort? 2.What worked well regarding your team work? 3.What would you do different regarding team work? 4.What insights do you have regarding how to provide feedback? 5.In your opinion, is it worthwhile to gather data and do benchmarking? Why? 6.What were the main insights your sponsor had during the feedback? 7.Did your sponsor find the effort valuable? Why?

11. 11 What changes physician’s practice patterns? Small group discussion. Use Nominal group technique. Have a facilitator, time keeper and reporter

12. 12 Traditional Forms of Continuing Medical Education Either have not looked for changes in patient outcomes or have not found that the programs succeeded in improving patient outcomes

13. 13 Clinical Practice Guidelines Remarkably unsuccessful in influencing physicians practices much less changing patient outcomes

14. 14 Academic Detailing Effective in changing practice patterns in virtually every study in which it was used

15. 15 Physician Profiling Feedback us an effective means of altering practices

16. 16 Participation in Change & CQI Uncontrolled evaluations suggest that these methods can improve the process of care

17. 17 Administrative Interventions Second opinion not effective. Utilization review not effective in reducing overall cost. May have unusual side effects.

18. 18 Financial Incentives No randomized studies but observational studies suggest a large impact.

19. 19 Changing Patients’ Attitudes Yes, effective in changing physician’s practice patterns

20. 20 Just in Time Reminders Yes, effective in changing practice patterns