Résumé :
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[BDSP. Notice produite par INIST-CNRS qw18R0xn. Diffusion soumise à autorisation]. Context Performance feedback and benchmarking, common tools for health care improvement, are rarely studied in randomized trials. Achievable Benchmarks of Care (ABCs) are standards of excellence attained by top performers in a peer group and are easily and reproducibly calculated from existing performance data. Objective To evaluate the effectiveness of using achievable benchmarks to enhance typical physician performance feedback and improve care. Design Group-randomized controlled trial conducted in December 1996, with follow-up through 1998. Setting and Participants Seventy community physicians and 2978 fee-for-service Medicare patients with diabetes mellitus who were part of the Ambulatory Care Quality Improvement Project in Alabama. Intervention Physicians were randomly assigned to receive a multimodal improvement intervention, including chart review and physician-specific feedback (comparison group ; n=35) or an identical intervention plus achievable benchmark feedback (experimental group ; n=35). Main Outcome Measure Preintervention (1994-1995) to postintervention (1997-1998) changes in the proportion of patients receiving influenza vaccination ; foot examination ; and each of 3 blood tests measuring glucose control, cholesterol level, and triglyceride level, compared between the 2 groups. Results The proportion of patients who received influenza vaccine improved from 40% to 58% in the experimental group (P<. vs from to in the comparison group odds ratios for patients of achievable benchmark physicians who received appropriate care after intervention adjusted preintervention and nesting within were confidence interval influenza vaccination ci foot examination long-term glucose control measurement.>
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