A multi-faceted provider education program designed for consistent, evidence-based clinical practice change within an integrated care delivery syste

Article type
Okawa G1
1Kaiser Permanente, USA
Background: An ongoing challenge in medical education is demon- strating its ability to help implement evidence-based care, enable sustainable clinical practice change, and reduce unnecessary variations in care delivery. In 2009, an integrated care delivery system in the U.S. launched a multi-faceted organization-based provider education program strategically designed to improve the consistency and quality of care.

Objectives: The primary objective was to design a provider education program integrating multiple strategies for guideline imple- mentation and medical education to improve the quality, consistency, and sustainability of care. This required clarifying practice standards using the best available evidence, gaining agreement across clinical departments, creating multi-faceted medical education interventions, and developing operational processes to optimize the care delivery system.

Methods: Executive leadership identifies key clinical quality gaps and provides sponsorship for the planned interventions. Evidence-based methods are used to formulate clinical practice recommendations based on the best available evidence. Multi-faceted medical education is designed to communicate the key clinical recommendations. Operational processes, audit and feedback, clinical champions, and point-of-care decision support are created to sustain practice change. Objective measures are used to identify baseline performance and to monitor for process improvement over time. Be careful about switching from past tense to present tense.

Results: Initial 6-month data shows improvement in several process measures following medical education interventions. Examples include a 4% improvement in the number of diabetic patients with a HBA1C of <9%, a 3.4% improvement in the number of patients achieving a target LDL <100, and a 14.4% improvement in the number of referred patients with a complete hematuria evaluation.

Conclusions: Medical education, designed strategically, may be effective within a large integrated care delivery system in improving the consistency and quality of clinical care.