Use of physician-specific data and flow sheets to improve compliance with preventive and screening health care...

The benefits of preventive and screening health-care measures have been well documented, but physician compliance with these measures has been imperfect. This investigation sought to measure and improve compliance of seven internists with a range of health-care measures.

This study had two parts. Part 1: Office medical records of seven internists were scored on 36 measures. Physicians were given their individual and group scores to determine if such data would improve future compliance with these measures. A second record review was performed six months later, and the two compliance scores for both individual physician and the group were compared. Part 2: A flow sheet utilizing these 36 measures was custom designed for each physician to determine if this tool would increase compliance rates over those determined in Part 1.

Part 1: Baseline compliance with health measures by these internists was approximately 75%. Providing individual and group scores to physicians had no significant effect on compliance with these health-care measures as measured by the second record review. Part 2: Custom designed flow sheets provided comparable compliance rates and were as effective as record review in assessing compliance, with some measures improving and some declining in comparison scores on Part 1. The flow sheet itself, however, did not increase overall compliance scores either for individual physicians or the group as a whole.

Baseline compliance with health-care measures was higher in this investigation than reported elsewhere. Neither data feedback nor redesigned flow sheets increased overall compliance rates, but flow sheets were superior in documenting some frequently updated items, such as medication lists. Flow sheets were inexpensive and easy to implement. Additionally, flow sheets allowed for more rapid assessment of physician performance than time-consuming chart review. Until superior methods are widely available, the use of flow sheets in ambulatory care should be encouraged.