Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial.

Background: Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients.

Objective: In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS).

Methods: We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking.

Evidence-based choices of physicians: a comparative analysis of physicians participating in Internet CME and non-participants.

Background: The amount of medical education offered through the Internet continues to increase, providing unprecedented access for physicians nationwide. However, the process of evaluating these activities is ongoing. This study is a continuation of an earlier report that found online continuing medical education (CME) to be highly effective in making evidence-based decisions.

Management of female sexual problems: perceived barriers, practice patterns, and confidence among primary care physicians and gynecologists.

Introduction: Although approximately 40% of women report female sexual problems--and particularly sexual desire disorders, there are numerous practical, professional, and personal barriers to their diagnosis and management by treating clinicians.

Aim: To identify practice patterns, perceptions, and barriers to the diagnosis and management of female sexual problems among U.S.

How does older age influence oncologists' cancer management?

Background: Over half of new cancer cases occur in patients aged > or = 65 years. Many older patients can benefit from intensive cancer therapies, yet evidence suggests that this population is undertreated.

Methods: To assess preferences and influential factors in geriatric cancer management, practicing U.

Practice patterns and guideline adherence of medical oncologists in managing patients with early breast cancer.

Background: Studies of adherence to breast cancer guidelines have often focused on primary therapies, but concordance with other guideline recommendations has not been examined as extensively. This study assesses the knowledge and practice patterns of medical oncologists in the United States to inform education and quality improvement initiatives that can improve breast cancer care.

Methods: A survey containing case vignettes and related questions was developed to examine oncologists' clinical decision-making in evaluating and treating women with early breast cancer.

Improving the physician-patient cardiovascular risk dialogue to improve statin adherence.

Background: The purpose of this study was to evaluate the effectiveness of a patient education program developed to facilitate statin adherence.

Methods: A controlled trial was designed to test the effectiveness of a multifaceted patient education program to facilitate statin adherence. The program included a brief, in-office physician counseling kit followed by patient mailings.

A controlled trial of the effectiveness of internet continuing medical education.

Background: The internet has had a strong impact on how physicians access information and on the development of continuing medical education activities. Evaluation of the effectiveness of these activities has lagged behind their development.

Methods: To determine the effectiveness of a group of 48 internet continuing medical education (CME) activities, case vignette surveys were administered to US physicians immediately following participation, and to a representative control group of non-participant physicians.

Knowledge and attitudes of primary care physicians in the management of patients at risk for cardiovascular events.

Background: Adherence to clinical practice guidelines for management of cardiovascular disease (CVD) is suboptimal. The purposes of this study were to identify practice patterns and barriers among U.S.

Enhancing COPD management in primary care settings.

Context: Primary care physicians provide care for the majority of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD). Although clinical practice guidelines have been developed for COPD, their influence on primary care practice is unclear.

Objective: To examine primary care decision making, perceptions, and educational needs relating to COPD.

A standardized approach to assessing physician expectations and perceptions of continuing medical education.

Introduction: Rapidly expanding science and mandates for maintaining credentials place increasing demands on continuing medical education (CME) activities to provide information that is current and relevant to patient care. Quality may be seen as the perceived level of service measured against consumer expectations. Standard tools have not been developed to determine how well CME activities meet consumer expectations.

Using a modified nominal group technique to elicit director of nursing input for an osteoporosis intervention.

Background: Barriers prevent osteoporosis care in nursing homes. Successful interventions designed to circumvent these barriers benefit from target recipient input during development.

Objective: To elicit suggestions for an osteoporosis quality improvement intervention designed for use by nursing home health care professionals.

Evaluation of an online bioterrorism continuing medical education course.

Introduction: Much of the international community has an increased awareness of potential biologic, chemical, and nuclear threats and the need for physicians to rapidly acquire new knowledge and skills in order to protect the public's health. The present study evaluated the educational effectiveness of an online bioterrorism continuing medical education (CME) activity designed to address clinical issues involving suspected bioterrorism and reporting procedures in the United States.

Methods: This was a retrospective survey of physicians who had completed an online CME activity on bioterrorism compared with a nonparticipant group who had completed at least 1 unrelated online CME course from the same medical school Web site and were matched on similar characteristics.

Information-seeking behaviors and reflective practice.

Introduction: As they care for patients, physicians raise questions, but they pursue only a portion of them. Without the best information and evidence, care and patient safety may be compromised. Understanding when and why problems prompt physicians to look for information and integrate results into their knowledge base is critical and shapes one part of reflection about care.

Improving physician performance through Internet-based interventions: who will participate?

Background: The availability of Internet-based continuing medical education is rapidly increasing, but little is known about recruitment of physicians to these interventions.

Objective: The purpose of this study was to examine predictors of physician participation in an Internet intervention designed to increase screening of young women at risk for chlamydiosis.

Methods: Eligibility was based on administrative claims data, and eligible physicians received recruitment letters via fax and/or courier.

Attributes of an ideal continuing medical education institution identified through nominal group technique.

Introduction: Continuing medical education (CME) is an important resource physicians use to maintain their clinical competence. While many options for CME programs are available, there are few measures of their impact and few measures for physicians to use to systematically gauge their efforts in maintaining competence. This study initiates a process designed to identify key attributes of an ideal CME institution, defined as one that facilitates ways for individual physicians to maintain their competence.

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid-treated patients.

Objective: To evaluate patient and physician factors associated with prevention of glucocorticoid-induced osteoporosis and to describe temporal trends in screening and prevention of glucocorticoid-induced osteoporosis.

Methods: Using databases from a national managed care organization, enrollees who had been prescribed glucocorticoids (taken for at least 60 days) during an 18-month period were identified. Administrative data from January 2001 through June 2003 and linked survey data from October 2003 were examined for measurement of bone mass, prescription of antiresorptive medication, and use of over-the-counter calcium and/or vitamin D treatment.

Chlamydia screening of at-risk young women in managed health care: characteristics of top-performing primary care offices.

Objectives: Despite effective approaches for managing chlamydial infection, asymptomatic disease remains highly prevalent. We linked administrative data with physician data from the American Medical Association physician survey to identify characteristics of primary care offices associated with best chlamydia screening practices.

Study: Criteria from the National Committee for Quality Assurance provided chlamydia screening rates.

Barriers to providing osteoporosis care in skilled nursing facilities: perceptions of medical directors and directors of nursing.

Objectives: The objectives of this study were to identify the barriers to osteoporosis clinical practice guideline use perceived by Medical Directors (MED DIR) and Directors of Nursing (DON) in skilled nursing facilities; and to describe differences in the perceptions of MED DIRs and DONs.

Design: The authors conducted a cross-sectional national survey.

Participants: This study consisted of a random national sample of MED DIRs (n = 1300) and DONs (n = 1300) belonging to the American Medical Directors Association or the National Association of Directors of Nursing Administration in Long-term Care.

Family physicians' information seeking behaviors: a survey comparison with other specialties.

Background: Using technology to access clinical information has become a critical skill for family physicians. The aims of this study were to assess the way family physicians use the Internet to look for clinical information and how their patterns vary from those of specialists. Further, we sought a better understanding of how family physicians used just-in-time information in clinical practice.

Multicomponent Internet continuing medical education to promote chlamydia screening.

Background: Low Chlamydia trachomatis screening rates create an opportunity to test innovative continuing medical education (CME) programs. Few studies of Internet-based physician learning have been evaluated with objective data on practice patterns.

Design: This randomized controlled trial tested a multicomponent Internet CME (mCME) intervention for increasing chlamydia screening of at-risk women aged 16 to 26 years.

Online bioterrorism continuing medical education: development and preliminary testing.

Objective: Education to achieve awareness and competency in responding to incidents of bioterrorism is important for health care professionals, especially emergency physicians and nurses, who are likely first points of medical contact. The authors describe the development of a computer-based approach to initial education, incorporating a screensaver to promote awareness and a Web-based approach to provide initial content competency in the areas of smallpox and anthrax.

Methods: Screensavers were developed and tested on emergency department rotating senior medical students and internal medicine interns.

Barriers to providing osteoporosis care in skilled nursing facilities: perceptions of medical directors and directors of nursing.

Objectives: The objectives of this study were to identify the barriers to osteoporosis clinical practice guideline use perceived by Medical Directors (MED DIR) and Directors of Nursing (DON) in skilled nursing facilities; and to describe differences in the perceptions of MED DIRs and DONs.

Design: The authors conducted a cross-sectional national survey.

Participants: This study consisted of a random national sample of MED DIRs (n=1300) and DONs (n=1300) belonging to the American Medical Directors Association or the National Association of Directors of Nursing Administration in Long-term Care.

Using email reminders to engage physicians in an Internet-based CME intervention.

Background: Engaging practicing physicians in educational strategies that reinforce guideline adoption and improve the quality of healthcare may be difficult. Push technologies such as email offer new opportunities to engage physicians in online educational reinforcing strategies. The objectives are to investigate 1) the effectiveness of email announcements in engaging recruited community-based primary care physicians in an online guideline reinforcement strategy designed to promote Chlamydia screening, 2) the characteristics of physicians who respond to email announcements, as well as 3) how quickly and when they respond to email announcements.

Standardizing evaluation of on-line continuing medical education: physician knowledge, attitudes, and reflection on practice.

Introduction: Physicians increasingly earn continuing medical education (CME) credits through on-line courses, but there have been few rigorous evaluations to determine their effects. The present study explores the feasibility of implementing standardized evaluation templates and tests them to evaluate 30 on-line CME courses.

Methods: A time series design was used to compare the knowledge, attitudes, and reported changes in practice of physician participants who completed any of 30 on-line CME courses that were hosted on an academic CME Web site and a CME Web portal during the period from August 1, 2002, through March 31, 2003.