Physician involvement in quality assurance.

Effective physician involvement in quality assurance in hospitals is necessary both to identify problems in patient care and to bring about problem resolution. This report describes a controlled, longitudinal study designed to measure effects on physician performance of involving physicians in setting medical audit criteria, reviewing audit results, and receiving concurrent reminders on a case-by-case basis. Unexpected low hemoglobin levels was the topic for audit. During phase 1 of the study, three randomly composed physician groups were involved in criteria setting plus review of audit results, review of audit results alone, or no treatment. During phase 2, 6 months later, the physicians in all three groups were exposed to 4 months of concurrent reminders. During phase 1, the group involved in review of audit results only achieved 51% compliance with the preset criteria compared with 26% for the group involved in criteria setting and review of audit results (P = 0.002). During phase 2, when concurrent reminders were provided, the group that was formerly the control group in phase 1, achieved 77% compliance as compared with 56% for the group previously involved in criteria setting and review of audit results (P = 0.004). These findings challenge the common assumption that physicians should be involved in criteria setting. They also suggest that providing the individual physician with information concurrently on a case-by-case basis may be superior to reviewing audit results for changing physician behavior.