Measuring and Improving Physician Compliance with Clinical Practice Guidelines: A Controlled Interventional Trial

Ag, Ellrodt; Conner, Latoya C.; Riedinger, Mary S.; Weingarten, Scott

doi:10.7326/0003-4819-122-4-199502150-00007

Cited by 142 publications

(38 citation statements)

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“…Previous studies have demonstrated variable results predicting physicians' use of health care resources, 10 including guidelines, decision rules and care plans; 11,12 and admitting practices 13,14 using a variety of predictor variables. The outcomes of our analysis are largely consistent with Reilly and coworkers' 15 finding that physicians vary widely in their clinical decisions about simulated cases, regardless of specialty, level of training or clinical experience.…”

Section: Discussionmentioning

confidence: 99%

Individual emergency physician admission rates: predictably unpredictable

Mutrie

Bailey

Malik

2009

CJEM

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Objective: We sought to determine the degree and possible causes of variability in admission practices among individual emergency physicians (EPs) at 1 emergency department (ED) using a Canadian Emergency Department Triage Acuity Scale (CTAS)-matched ED patient population. Methods: We distributed a survey measuring attitudes and demographics to all EPs (n = 30) at a large regional hospital. Hospital admissions data from 1 calendar year were matched to individual EP survey results. Emergency physicians were ranked as "lower," "average" or "higher" admitters and, using these categorical variables, the data set was analyzed for correlations and trends. Results: Overall, 97.0% of the EPs responded to the survey. Admissions by EPs ranged from 8.7% to 17.0%, (mean 12.52, standard deviation [SD] 2.21) of all patients seen. CTAS category-specific admission data demonstrated variability in the admission ranking of individual EPs. No EPs consistently performed at any 1 admission ranking across all CTAS categories. More years of emergency medicine experience was significantly correlated with higher admissions in the CTAS-2 ranking (r = 0.4, p < 0.05). Whether a physician worked full-time, part-time or as a locum was not associated with patterns of admission, nor was any particular postgraduate certification (e.g., CCFP, CCFP EM, FRCPC) or any of the surveyed attitudinal traits. Conclusion: Individual EPs' overall and CTAS-specific admissions varied substantially, and followed an approximately normal distribution curve. Emergency physicians with more years of experience had a statistically higher CTAS-2 admission rate; however, other variables, including postgraduate certification status, decision-related attitudes toward admission, and reported practices were not associated with admission proportions. Emergency physicians tend to have uniquely individual admission ranking profiles across all the CTAS categories.

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Section: Discussionmentioning

confidence: 99%

Individual emergency physician admission rates: predictably unpredictable

Mutrie

Bailey

Malik

2009

CJEM

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“…Lack of staff time and lack of resources to make changes may be a factor. Simple inertia, lack of motivation, or refusal has been shown to play a small role (26).…”

Section: Guideline Implementationmentioning

confidence: 99%

Compliance with Gastric-Emptying Scintigraphy Guidelines: An Analysis of the Intersocietal Accreditation Commission Database

Farrell¹,

Costello²,

McKee

et al. 2017

J. Nucl. Med. Technol.

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CE credit: For CE credit, you can access the test for this article, as well as additional JNMT CE tests, online at https://www.snmmilearningcenter.org. Complete the test online no later than March 2020. Your online test will be scored immediately. You may make 3 attempts to pass the test and must answer 80% of the questions correctly to receive 1.0 CEH (Continuing Education Hour) credit. SNMMI members will have their CEH credit added to their VOICE transcript automatically; nonmembers will be able to print out a CE certificate upon successfully completing the test. The online test is free to SNMMI members; nonmembers must pay $15.00 by credit card when logging onto the website to take the test.Many variables can influence the results of gastric emptying scintigraphy (GES). A lack of methodologic standardization may cause variability, limit comparisons, and decrease the credibility of the test. To address this, in 2009, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published a procedure guideline describing a standardized, validated GES protocol for adults. Laboratories must closely follow the consensus protocol to provide valid and standardized results and improve patient care. The Intersocietal Accreditation Commission (IAC) evaluates compliance with guidelines as part of the accreditation process. The rate of compliance with the GES guideline at a national level has not been assessed. The aim of this study was to quantify compliance with the standardized protocol in a large cohort of laboratories from different institutions and practice settings across the United States. Methods: The IAC Nuclear/PET database was used to extract GES protocols from all laboratories applying for accreditation from 2013 to 2015. Each protocol was assessed for compliance with the methods described in the SNMMI GES procedure guidelines. Fourteen binary variables were assessed: patient preparation (4 variables), meal content (5 variables), acquisition (2 variables), and processing (3 variables). Results: Protocols from 127 labs demonstrated that patient preparation was the category with which the laboratories were least compliant. Instructions for blood glucose monitoring and withholding of medications were problematic. Overall, 69.3% of protocols were not compliant with the content or preparation of the consensus meal: 47.3% used whole eggs instead of egg whites, and additional ingredients not recommended in the guidelines were also frequently used. Only 3.1% of laboratories were fully compliant with all 14 variables. Over half the laboratories were compliant with only 5 variables or less. Conclusion: Almost 8 y after the publication of the SNMMI GES guidelines, there is low protocol adherence among laboratories applying for IAC Nuclear/PET accreditation. This substantial degree of guideline noncompliance is concerning. The variability in GES protocols may have a significant effect on patient management, as results may be inaccurate. Consistent use of the standardized GES protocol permits interpretation of results in...

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“…As other authors have pointed out, acceptance depends not only on physicians' trust, but also on at least three other aspects: the magnitude of changes in practice imposed, and the removal of both administrative inefficiencies and negative financial incentives (Grol et al, 1998;Ellrodt et al, 1995). In the case of guidelines for cancer treatment, all three aspects are to be found to a certain extent depending on the topic.…”

Section: Dissemination Of Guidelinesmentioning

confidence: 99%