International Journal for Quality in Health Care Advance Access originally published online on April 14, 2005
International Journal for Quality in Health Care 2005 17(5):427-431; doi:10.1093/intqhc/mzi044
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Failure of Internet-based audit and feedback to improve quality of care delivered by primary care residents
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, USA
Objective. To determine the effectiveness of Internet-based audit and feedback to physicians to improve care for diabetes and hypertension.
Design. Time-series analysis of an intervention.
Methods. The study setting was Harvard Vanguard Medical Associates, a 14-site multispecialty group in greater Boston. The study period was July 1997–June 1999. Participants were 12 primary care internal medicine residents who provided care to adult patients with diabetes (n = 76 pre-intervention and n = 88 post-intervention), hypertension (n = 329 pre-intervention and n = 338 post-intervention), or both (n = 62 pre-intervention and n = 71 post-intervention). We determined the proportion of each resident’s patients whose care fulfilled national guidelines for quality (i.e. diabetes patients had hemoglobin testing in the previous 6 months or hypertension patients received a ß-blocker or diuretic in the same time period). After meeting individually with each resident to obtain informed consent and to encourage participation, we sent each resident information for accessing his or her practice profile on a secure website. The main outcome measures were (i) the proportion of resident physicians who accessed their profiles and (ii) change following the intervention in the proportion of patients whose care followed national guidelines.
Results. Over a 1-year period, only four of the 12 residents accessed their websites. One of the residents visited her site three times, while the other three residents visited their sites once each. In interrupted time-series analyses, the intervention had no discernible effect on adherence to practice guidelines for diabetes or hypertension.
Conclusion. The lack of participation in this Internet-based intervention may have important implications for the development of future programs that require physicians to interact with technology to improve quality of care.
Keywords: diabetes mellitus, graduate medical education, guideline adherence, hypertension, managed care programs, quality of health care
Address reprint requests to Steven R. Simon, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, Sixth Floor, Boston, MA 02215, USA. E-mail: steven_simon{at}hms.harvard.edu
Accepted for publication March 8, 2005.