International Journal for Quality in Health Care Advance Access published online on December 1, 2009
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzp054
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Association between primary care physicians' evidence-based medicine knowledge and quality of care
1 School of Public Health, University of Haifa, Haifa, Israel
2 Center for Clinical Quality & Safety, Hadassah Hebrew University Medical Center, Jerusalem, Israel
3 The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
4 Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
5 Galil Center for Medical Informatics, Telemedicine and Personalized Medicine; and The R&B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
6 Department of Medical Education, The R&B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
7 Clinical Epidemiology, Rambam Medical Center, Haifa, Israel
Objective. Ample research has examined physicians' evidence-based medicine (EBM) knowledge and skills; however, previous research has not linked EBM knowledge to objective measures of process of care.
Design. A cross-sectional study of quality of care measures extracted from electronic medical records and EBM knowledge assessed via a validated questionnaire.
Setting. One region of the largest Health Maintenance Organization in Israel.
Participants. Seventy-four physicians and their 8334 diabetic patients, 7092 coronary heart disease patients and 17 132 hypertensive patients.
Main outcome measures. Outcome measures were four diabetes quality of care indicators (LDL tests, microalbumin tests, hemoglobin A1C tests, eye examination referrals), and two drug prescription indicators (statin prescription for coronary heart disease patients, and thiazide prescription for hypertensive patients). Independent variables were total EBM knowledge and its components: critical appraisal and information retrieval.
Results. Total EBM knowledge was independently and significantly associated with LDL testing (b = 0.13; P = 0.036), microalbumin testing (b = 0.33; P = 0.001), hemoglobin A1C testing (b = 0.17; P = 0.036), eye examination referrals (b = 0.16; P = 0.021) and statin prescriptions (b = 0.18; P = 0.025). Critical appraisal was independently associated with microalbumin tests (b = 0.46; P = 0.002) and eye examination referrals (b = 0.20; P = 0.048). Information retrieval was only independently associated with hemoglobin A1C testing (b = 0.43; P = 0.004). Thiazide prescription was not associated with EBM knowledge scores.
Conclusions. Physicians' higher total EBM knowledge primarily correlates with better quality of care; however, correlations were modest and explained only a small portion in the variance of clinical performance. Results indicate that there might be a need to focus on teaching all the components of EBM rather than EBM microskills.
Keywords: evidence-based medicine, quality of care, primary care
Address reprint requests to: Kerem Shuval, School of Public Health, Dallas Regional Campus, University of Texas, 6011 Harry Hines Blvd., Dallas, TX 75390, USA. Tel: +1-214-6481094; Fax: +1-2146481081; E-mail: kerem.shuval{at}utsouthwestern.edu
Accepted for publication November 4, 2009.