Published in:
01-05-2022 | Care | Original Research
Effect of Peer Benchmarking on Specialist Electronic Consult Performance in a Los Angeles Safety-Net: a Cluster Randomized Trial
Published in: Journal of General Internal Medicine | Issue 6/2022
Login to get accessABSTRACT
Background
Since the advent of COVID-19, accelerated adoption of systems that reduce face-to-face encounters has outpaced training and best practices. Electronic consultations (eConsults), structured communications between PCPs and specialists regarding a case, have been effective in reducing face-to-face specialist encounters. As the health system rapidly adapts to multiple new practices and communication tools, new mechanisms to measure and improve performance in this context are needed.
Objective
To test whether feedback comparing physicians to top performing peers using co-specialists’ ratings improves performance.
Design
Cluster-randomized controlled trial
Participants
Eighty facility-specialty clusters and 214 clinicians
Intervention
Providers in the feedback arms were sent messages that announced their membership in an elite group of “Top Performers” or provided actionable recommendations with feedback for providers that were “Not Top Performers.”
Main Measures
The primary outcomes were changes in peer ratings in the following performance dimensions after feedback was received: (1) elicitation of information from primary care practitioners; (2) adherence to institutional clinical guidelines; (3) agreement with peer’s medical decision-making; (4) educational value; (5) relationship building.
Key Results
Specialists showed significant improvements on 3 of the 5 consultation performance dimensions: medical decision-making (odds ratio 1.52, 95% confidence interval 1.08–2.14, p<.05), educational value (1.86, 1.17–2.96) and relationship building (1.63, 1.13–2.35) (both p<.01).
Conclusions
The pandemic has shed light on clinicians’ commitment to professionalism and service as we rapidly adapt to changing paradigms. Interventions that appeal to professional norms can help improve the efficacy of new systems of practice. We show that specialists’ performance can be measured and improved with feedback using aspirational norms.
Trial Registration
clinicaltrials.gov NCT03784950