Physician-To-Physician Comparison May Improve Outcomes

For example, evaluating how head and neck surgeons at different medical institutions follow accepted guidelines for oral cavity cancer management and then comparing oneself to those peers can inform a practitioner of areas for practice improvement, said Dr. Eisele. “This type of assessment is basically the mechanism by which you get feedback,” he added. “You compare yourself to others and then you actively make changes to practice to better conform to guidelines and best practices.”

Dr. Eisele stressed that any kind of peer comparison methods in otolaryngology that are incorporated into the MOC would be beneficial to all otolaryngologists. “This process will be designed so it is not an onerous time commitment, and it will be fairly painless once the process is initiated,” he said. “We don’t want this to be a burden for our diplomates; we want it to enhance their practice in medicine, with better outcomes and more healthy patients. All physicians want to improve patient care, and we expect that this will help.”

That’s a goal echoed by Dr. Doctor. “We are trying to move toward an understanding of what practices are harmful or provide low-value care,” he said. “If they are harmful or not valuable for patients, we shouldn’t do them.”

Cheryl Alkon is a freelance medical writer based in Massachusetts.

Poster-Sized Commitment

A 2014 study published in JAMA Internal Medicine and coauthored by Dr. Doctor used the principle of publication commitment to change prescriber behavior (JAMA Intern Med. 2014 Mar;174:425–431). In a signed letter to patients, clinicians discussed the importance of lowering the rate of inappropriate antibiotic prescribing and stated their dedication to prescribing antibiotics only when they are absolutely necessary.

These letters were enlarged to poster size and placed in exam rooms. This tactic, or “nudge,” as study authors called it, reduced rates by nearly 20%.

Accountable Justification

Accountable justification is an EHR-based intervention used in Dr. Doctor’s JAMA study. An EHR prompt asked each clinician seeking to prescribe an antibiotic to explicitly justify, in a free-text response, his or her treatment decision. The prompt also informed clinicians that this written justification would be visible in the patient’s medical record as an “antibiotic justification note” and that if no justification was entered, the phrase “no justification given” would appear.

Encounters could not be closed without the clinician’s acknowledgment of the prompt, but clinicians could cancel the antibiotic order to avoid creating a justification note, if they chose. The accountable justification alert was triggered for both antibiotic-inappropriate diagnoses and potentially antibiotic-appropriate acute respiratory tract infection diagnoses (e.g., acute pharyngitis).