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

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    Authors
    Fihn, Stephan D.
    McDonell, Mary B.
    Diehr, Paula
    Anderson, Stephen M.
    Bradley, Katharine A.
    Au, David H.
    Spertus, John A.
    Burman, Marcia
    Reiber, Gayle E.
    Kiefe, Catarina I.
    Cody, Marisue
    Sanders, Karen M.
    Whooley, Mary A.
    Rosenfeld, Kenneth
    Baczek, Linda A.
    Sauvigne, Arthur
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    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2004-02-19
    Keywords
    Aged
    Chronic Disease
    Female
    *Health Status
    Health Surveys
    Humans
    Male
    Medical Audit
    *Patient Satisfaction
    Physical Fitness
    *Primary Health Care
    Questionnaires
    United States
    United States Department of Veterans Affairs
    Bioinformatics
    Biostatistics
    Epidemiology
    Health Services Research
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    http://dx.doi.org/10.1016/j.amjmed.2003.10.026
    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.
    Source
    Am J Med. 2004 Feb 15;116(4):241-8. Link to article on publisher's site
    DOI
    10.1016/j.amjmed.2003.10.026
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47651
    PubMed ID
    14969652
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.amjmed.2003.10.026
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