Changing Clinical Practice:  Prospective Study of the Impact of Continuing Medical Education and Quality Assurance Programs on Use of Prophylaxis for Venous Thromboembolism

Frederick A. Anderson Jr, PhD; H. Brownell Wheeler, MD; Robert J. Goldberg, PhD; David W. Hosmer, PhD; Ann Forcier; Nilima A. Patwardhan, MD
Arch Intern Med. 1994;154(6):669-677. doi:10.1001/archinte.1994.00420060103011.
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Objective:  To determine the effect of continuing medical education (CME) with and without a quality assurance component (CME+QA) on physician practices in the prevention of venous thromboembolism.

Methods:  A communitywide study was performed in 15 short-stay hospitals in central Massachusetts. The study population included 3158 patients in acute-care hospitals with multiple risk factors for venous thromboembolism. Study hospitals were randomly assigned to one of two educational strategies or to a control group that received no intervention.

Results:  The proportion of patients at high risk for venous thromboembolism who received effective methods of prophylaxis increased significantly from 29% in 1986 to 52% in 1989 (P<.001). This increase was seen in all study groups: control hospitals, 40% to 51% (P<.001); CME hospitals, 21% to 49% (P<.0001); and CME+QA hospitals, 27% to 55% (P<.0001). The increase in prophylaxis use from 1986 to 1989 was significantly greater among patients cared for in hospitals whose physicians participated in a formal CME program (an increase of 28%) than in control hospitals (an increase of 11%) (P<.001). There was no significant difference in the use of prophylaxis in hospitals whose physicians received CME+QA interventions compared with hospitals whose physicians received CME interventions alone (identical increases of 28%).

Conclusion:  A formal CME program significantly increased the frequency with which physicians prescribed prophylaxis for venous thromboembolism. We believe the key factor in our CME interventions that motivated clinicians to change their practices was the provision of hospital-specific data demonstrating a compelling need for improvement. Despite the substantial investment by hospitals in QA, traditional QA intervention appeared to provide no additional benefit. Even after extensive CME/QA interventions, prophylaxis for venous thromboembolism remained underutilized, suggesting the need to develop new approaches to changing clinical practice.(Arch Intern Med. 1994;154:669-677)


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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