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Biomedical subjects

M Pelter

Publications and source records attributed to M Pelter.

7 recordsLinked to original sources
PubMed2000

Can peer-comparison feedback improve patient functional status?

OBJECTIVE: To determine whether providing physicians with peer-comparison feedback can improve patient functional status. STUDY DESIGN: Randomized, controlled, comparative study. METHODS: Forty-eight primary care physicians at Kaiser Permanente Woodland Hills, a group-model health maintenance organization in southern California, were randomly assigned to an intervention group or a control group. All physicians were informed that their elderly patients (randomly selected patients aged 65 to 75) would be monitored. Physicians in the intervention group received aggregated peer-comparison feedback data (physician "report cards") on the functional status of their elderly patients. Physicians in the control group received only general information that their patients' functional status would be monitored. The effect of the intervention on patients' functional status was determined by comparing responses to surveys completed by the patients at baseline and after the intervention. RESULTS: Patients in both the control and intervention groups had a statistically significant decrease in functional status, including decreases in their ability to complete daily activities and increases in pain. In addition, patients in the control group reported a significant decrease in social activities, physical fitness, and feelings. In the intervention group, patients also experienced a significant decrease in social support. CONCLUSIONS: Educational interventions, including peer-comparison feedback, did not result in improvements in patient functional status. Research is desperately needed to identify interventions that can lead to improved health for elderly patients.

Activities of Daily Living↗
PubMed1999

Physician education and report cards: do they make the grade? results from a randomized controlled trial.

PURPOSE: We sought to determine whether tailored educational interventions call improve the quality of care, as measured by the provision of preventive care services recommended by the US Preventive Services Task Force, as well as lead to better patient satisfaction. SUBJECT AND METHODS: We performed a randomized controlled study among 41 primary care physicians who cared for 1,810 randomly selected patients aged 65 to 75 years old at Kaiser Permanente Woodland Hills, a group-model health maintenance organization in southern California. All physicians received ongoing education. Physicians randomly assigned to the comprehensive intervention group also received peer-comparison feedback and academic detailing. Baseline and postintervention (2 to 2.5 years later) surveys examining the provision of preventive care and patient satisfaction were performed and medical records were reviewed. RESULTS: Based on the results of patient surveys, there were significant improvements over time in the provision of preventive care in both the education and the comprehensive intervention groups for influenza immunization (79% versus 89%, P <0.01, and 80% versus 91%, P <0.01), pneumococcal immunization (42% versus 73%, P < 0.01 and 34% versus 73%, P < 0.01), and tetanus immunization (64% versus 72%, P <0.01, and 59% versus 79%, P <0.01). Mammography (90% versus 80%, P <0.01) and clinical breast examination (85% versus 79%, P <0.05) scores worsened in the education only group but not in the comprehensive intervention group. However, there were few differences in rates of preventive services between the groups at the end of the study, and the improvements in preventive care were not confirmed by medical record review. Patient satisfaction scores improved significantly in the comprehensive intervention group (by 0.06 points on a 1 to 5 scale, P = 0.02) but not in the education only group (by 0.02 points, P = 0.42); however, the improvement was not significantly greater in the comprehensive intervention group (P = 0.20). CONCLUSION: A physician-targeted approach of education, peer-comparison feedback, and academic detailing has modest effects on patient satisfaction and possibly on the offering of selected preventive care services. The lack of agreement between patient reports and medical records review raises concerns about current methods of ascertaining compliance with guidelines for preventive care.

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PubMed1998

Physicians' changing attitudes toward guidelines.

The objective of the study was to measure the change in physicians' attitudes toward preventive care guidelines over a 2-year period. The study was conducted at a Southern California managed care medical group that was experiencing intense price competition. We analyzed individualized survey responses of 62 HMO primary care physicians over the study period. We found that physicians increasingly believed that clinical guidelines were being used for cost containment (first survey 71% vs second survey 92%, p < .005) and less for quality improvement (first survey 85% vs second survey 67%, p < .008) over time. These findings may create a barrier to physicians' adoption of practice guidelines.

Adult↗
PubMed1997

Estimating ischemic burden: comparison of two formulas.

BACKGROUND: Complex formulas based on elevations of the ST segment on the ECG allow noninvasive estimation of ischemic burden. However, the formulas require elaborate computations that make them clinically useless, particularly in critical and emergent situations. Estimation of the amount of ischemic myocardium is useful in monitoring effects of therapeutic interventions. OBJECTIVE: To compare a simplified formula that sums ST-segment deviations in 12 ECG leads with formulas widely validated in clinical trials: anterior ischemic area = 3[1.5(number of leads ST increases) -0.4]; inferior ischemic area = 3[0.6(sigma ST increases II, III, aVF) +2.0]. METHODS: Data were collected from 46 patients undergoing angioplasty of the left anterior descending branch of the coronary artery or the right coronary artery who had changes in the ST segment denoting ischemia during balloon inflation. Absolute values of ST-segment elevations or depressions in the 12 standard ECG leads with a minimum deviation of 0.5 mm were added to determine the sum of the ST-segment deviations during ischemia of the left anterior descending branch of the coronary artery and ischemia of the right coronary artery. This sum was compared with the anterior and inferior ischemic area scores. The Pearson Product-Moment Correlation Coefficient was used to measure the association between the scores. RESULTS: The sum of ST-segment deviations for the left anterior descending branch correlated with the anterior ischemic area score, and the sum of ST-segment deviations for the right coronary artery correlated with the inferior ischemic area score. CONCLUSIONS: The complex, but validated, formulas for anterior ischemic area and inferior ischemic area correlate well with the simpler sum of ST-segment deviations. Because the simpler sum is more clinically useful, it may provide an alternative for monitoring ischemic burden.

Data Interpretation, Statistical↗
PubMed1995

The adoption of preventive care practice guidelines by primary care physicians: do actions match intentions?

OBJECTIVE: To measure primary care physicians' familiarity with, attitudes toward, and confidence in preventive care practice guidelines for the elderly and to determine whether their attitudes are associated with implementation of guidelines into clinical practice. DESIGN: A self-administered survey of physicians employed by a health maintenance organization (HMO) and of patients cared for by those physicians. Medical records were also reviewed to assess compliance with practice guidelines. SETTING: An HMO in Southern California. PARTICIPANTS: Forty-eight primary care physicians completed the survey (100% response rate). The medical records of 3,249 randomly selected elderly patients (65 to 75 years old) were studied. Of these patients, 2,799 completed a preventive care survey (response rate 86.1%). MEASUREMENT AND RESULTS: Most HMO primary care physicians agreed or strongly agreed that guidelines will improve quality of medical care (88%) and that guidelines have caused them to change their care of patients (73%). Although the physicians' general attitudes about guidelines did not often correlate with their use of preventive care guidelines, the physicians who stated that practice guidelines had changed their practices were more likely to offer their patients clinical breast examinations (75.9% vs 67.2%, p = 0.04) and to counsel their patients to exercise (70% vs 58%, p = 0.01) than were the physicians who did not. There was a significant association between physicians' support for and adoption of specific practice guidelines regarding mammography (r = 0.34, p = 0.02) and immunizations against influenza (r = 0.42, p < 0.005), pneumococcal pneumonia (r = 0.47, p < 0.001), and tetanus (r = 0.31, p = 0.03). CONCLUSIONS: Physicians employed by an HMO were familiar with and hopeful about the role of guidelines for improving patient care. Physicians' attitudes toward specific preventive care guidelines and admission that guidelines had caused them to change their practice did at times, but not always, correlate with their implementation of guidelines into clinical practice.

Adult↗
PubMed1995

A study of patient satisfaction and adherence to preventive care practice guidelines.

PURPOSE: Patient satisfaction ratings are being used to judge physicians' quality of care and to determine physician reimbursement. We therefore studied the association between patient satisfaction and the quality of medical care received by patients in physicians' offices. PATIENTS AND METHODS: Patient satisfaction was measured in a survey of patients cared for by 48 primary care physicians in a health maintenance organization in Southern California. Evidence that patients were offered or received preventive care services was determined by patient survey and medical record abstraction, respectively. The medical records of 3,249 randomly selected elderly patients (65 to 75 years old) were studied. Of these patients, 2,799 completed a patient satisfaction and preventive care services survey (response rate 86.1%), 2,654 completed a patient satisfaction survey (response rate 81.7%), and 2,258 completed a quality-of-life survey (response rate 69.5%). RESULTS: Patients were generally satisfied with their physicians' care (median satisfaction score 4.2; scale 1 to 5, 5 being most satisfied). Patients who received or were offered mammography, clinical breast examination, influenza vaccine, pneumococcal vaccine, tetanus vaccine, exercise counseling, and smoking cessation counseling were more satisfied with their medical care than those patients who did not (P < 0.001 for all tests). After controlling for the physician who was providing the medical care, there was still a statistically significant relationship between these factors and patient satisfaction. CONCLUSIONS: We found a significant association between patient satisfaction and the performance of some but not all preventive care services. However, we cannot be certain whether there is a relationship between patient satisfaction and quality of patient care.

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