| Intervention
Type |
Description
of Intervention |
Effectiveness
of Intervention |
| Education |
Distribution
of published or printed recommendations for clinical care, including
clinical practice guidelines, audiovisual materials, and electronic
publications. |
Most
studies using only printed material failed to demonstrate changes
in performance or health outcomes.7 |
| Conferences
|
Participation
of health care providers in conferences, lectures, workshops
or traineeships outside their practice settings |
When no explicit effort was made to determine practice needs or to facilitate practice change, these interventions failed to demonstrate change in performance or health outcomes. To be most effective, CME courses should be intensive and based on practice needs. 7 |
| Outreach
visits also called academic detailing |
Use of a trained person, usually a recognized, respected health professional, who meets with providers in their practice settings to educate them about desired clinical improvements. Interactions may include feedback on the provider’s clinical performance. |
Studies showed that outreach visits were effective in reducing inappropriate prescribing and, to a lesser extent, increasing the delivery of preventive services.7
Outreach visits, particularly when combined with social marketing, appear to be a promising approach to modifying health care professional behavior. 10 11
12 |
| Local
opinion leaders |
Use
of health care providers explicitly nominated by their colleagues to be
"educationally influential." These individuals are
respected and give credibility because of their clinical expertise
and social standing. |
The
effectiveness of opinion leaders ranged from non-significant
to substantial.7 Local opinion leaders may be important change
agents for some problems. In most trials, however, the role
of the opinion leaders was not clearly described.9 Local physician
champions engaged in clinical performance improvement initiatives
for diabetes management have led to some preliminary improvements
in quality of care indicators. 12 13
|
| Patient-mediated
interventions |
Any intervention aimed at changing the performance of health care professionals that involves direct messages to patients such as direct mailings, educational literature, counseling, interviews, or surveys. |
The
effectiveness was generally positive, particularly when combined
with academic detailing or provider education. 7
|
| Audit
and feedback |
Any
summary of clinical performance of health care over a specified
period, with or without recommendations for clinical action. |
The
effectiveness of audit and feedback across different types of
clinical behavior ranged from nil to moderate.7
It was particularly effective for prescribing practices and
diagnostic test ordering.8
|
| Reminders |
Any intervention that prompts the health care professional to perform a clinical action such as computerized prompting, administrative assistance, chart stickers, or inserts. |
Interventions that contain at least one element of the Chronic Care Model improve clinical outcomes and processes of care.14 |
| Social
Marketing |
Use of interview, focus group, or survey of targeted health care professionals to identify barriers to change and the subsequent design of an intervention. |
Studies demonstrated that learning experiences based on objective practice-needs assessment or knowledge testing could alter some aspects of health care professional performance.7
|
| Local
consensus processes |
Inclusion of health care professionals in discussion to ensure agreement that the chosen clinical problem is important and that the approach to managing it is appropriate. |
The
importance of local consensus processes was not clear. 7 |
Multifaceted |
Any
intervention that includes two or more of the interventions
descried above. |
The
use of a variety of interventions, such as audit and feedback,
reminders, outreach visits, patient-mediated interventions, or
opinion leaders, demonstrated changes in professional performance
and health outcomes. 7
|
