Context: Performance feedback and benchmarking, common tools for health care improvement, are rarely studied in randomized trials. Achievable Benchmarks of Care (ABCs) are standards of excellence attained by top performers in a peer group and are easily and reproducibly calculated from existing performance data. Objective: To evaluate the effectiveness of using achievable benchmarks to enhance typical physician performance feedback and improve care. Design: Group-randomized controlled trial conducted in December 1996, with follow-up through 1998. Setting and Participants: Seventy community physicians and 2978 fee-for-service Medicare patients with diabetes mellitus who were part of the Ambulatory Care Quality Improvement Project in Alabama. Intervention: Physicians were randomly assigned to receive a multimodal improvement intervention, including chart review and physician-specific feedback (comparison group; n=35) or an identical intervention plus achievable benchmark feedback (experimental group; n=35). Main Outcome Measure: Preintervention (1994-1995) to postintervention (1997-1998) changes in the proportion of patients receiving influenza vaccination; foot examination; and each of 3 blood tests measuring glucose control, cholesterol level, and triglyceride level, compared between the 2 groups. Results: The proportion of patients who received influenza vaccine improved from 40% to 58% in the experimental group (P<.001) vs from 40% to 46% in the comparison group (P=.02). Odds ratios (ORs) for patients of achievable benchmark physicians vs comparison physicians who received appropriate care after the intervention, adjusted for pre-intervention care and nesting of patients within physicians, were 1.57 (95% confidence interval [Cl], 1.26-1.96) for influenza vaccination, 1.33 (95% Cl, 1.05-1.69) for foot examination, and 1.33 (95% Cl, 1.04-1.69) for long-term glucose control measurement. For serum cholesterol and triglycerides, the achievable benchmark effect was statistically significant only after additional adjustment for physician characteristics (OR, 1.40 [95% Cl, 1.08-1.82] and OR, 1.40 [95% Cl, 1.09-1.79], respectively). Conclusion: Use of achievable benchmarks significantly enhances the effectiveness of physician performance feedback in the setting of a multimodal quality improvement intervention.
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