Clinical study
Effects of sustained audit/feedback on self-reported health status of primary care patients

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Abstract

Purpose

Because limited audit/feedback of health status information has yielded mixed results, we evaluated the effects of a sustained program of audit/feedback on patient health and satisfaction.

Methods

We conducted a group-randomized effectiveness trial in which firms within Veterans Administration general internal medicine clinics served as units of randomization, intervention, and analysis. Respondents to a baseline health inventory were regularly mailed the 36-Item Short Form (SF-36) and, as relevant, questionnaires about six chronic conditions (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, depression, alcohol use, and hypertension) and satisfaction with care. Data were reported to primary providers at individual patient visits and in aggregate during a 2-year period.

Results

Baseline forms were mailed to 34,050 patients; of the 22,413 respondents, 15,346 completed and returned follow-up surveys. Over the 2-year study, the difference between intervention and control groups (as measured by difference in average slope) was –0.26 (95% confidence interval [CI]: –0.79 to 0.27; P = 0.28) for the SF-36 Physical Component Summary score and –0.53 (95% CI: –1.09 to 0.03; P = 0.06) for the SF-36 Mental Component Summary score. No significant differences emerged after adjusting for deaths. There were no significant differences in condition-specific measures or satisfaction between groups after adjustment for provider type, panel size, and number of intervention visits, or after analysis of patients who completed all forms.

Conclusion

An elaborate, sustained audit/feedback program of general and condition-specific measures of health/satisfaction did not improve outcomes. To be effective, such data probably should be incorporated into a comprehensive chronic disease management program.

Section snippets

Setting and patients

ACQUIP was conducted between March 1997 and December 1999 in the general internal medicine clinics at seven Veterans Affairs (VA) medical centers (Birmingham, Alabama; Little Rock, Arkansas; Richmond, Virginia; San Francisco, California; Seattle, Washington; West Los Angeles, California; and White River Junction, Vermont). Each had established discrete firms, teams, or practices staffed by different groups of physicians caring for different patients. At each site, one randomly selected firm

Results

Of 34,050 eligible patients, 22,413 returned baseline health inventories and were mailed follow-up surveys. Of these, 15,346 responded to at least one mailing of the SF-36 and condition-specific questionnaires, and 9019 completed 2 years of follow-up (Figure 3). Sixty percent (13,478/22,413) of baseline respondents returned follow-up, condition-specific surveys.

Of 895 participating providers, 153 (17%) were staff physicians, 654 (73%) were physicians-in-training, and 88 (10%) were nurse

Discussion

In this 2-year randomized trial, outcomes were not improved by a sustained and comprehensive program of feedback of patients' perceived health and function plus an educational program for providers. The study had several strengths, including a large, diverse sample, a multicenter design, and the ability to assess factors that may have contributed to response bias. The intervention incorporated the input of many users and was implemented with the assistance of respected leaders at each site.

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    This study was supported by grants SDR 96-002 and IIR 99-376 from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, with Institutional Review Board approval. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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