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Implementing Achievable Benchmarks in Preventive Health: A Controlled Trial in Residency Education

Houston, Thomas K. MD, MPH; Wall, Terry MD, MPH; Allison, Jeroan J. MD, MSEpi; Palonen, Katri MD; Willett, Lisa L. MD; Keife, Catarina I. PhD, MD; Massie, F Stanford MD; Benton, E Cason MD; Heudebert, Gustavo R. MD, MDP

Academic Medicine:
doi: 10.1097/01.ACM.0000232410.97399.8f
Innovative Curricula
Abstract

Purpose: To evaluate the Preventive Health Achievable Benchmarks Curriculum, a multifaceted improvement intervention that included an objective, practice-based performance evaluation of internal medicine and pediatric residents’ delivery of preventive services.

Method: The authors conducted a nonrandomized experiment of intervention versus control group residents with baseline and follow-up of performance audited for 2001-2004. All 130 internal medicine and 78 pediatric residents at two continuity clinics at the University of Alabama School of Medicine, Birmingham, participated. Performance of preventive care was assessed by structured chart review. The multifaceted feedback curriculum included individualized performance feedback, academic detailing by faculty, and collective didactic sessions. The main outcome was difference in receipt of preventive care for patients seen by intervention and control residents, comparing baseline and follow-up.

Results: Charts were reviewed for 3,958 patients. Receipt of preventive care increased for patients of intervention residents, but not for patients of control residents. For the intervention group, significant increases occurred for five of six indicators in internal medicine: smoking screening, quit smoking advice, colon cancer screening, pneumonia vaccine, and lipid screening; and four of six in pediatrics: parental quit smoking advice, car seats, car restraints, and eye alignment (p < .05 for all). For control residents, no consistent improvements were seen. There was greater improvement for intervention than for control residents for four of six indicators in internal medicine, and two of six in pediatrics.

Conclusions: Using a multifaceted feedback curriculum, the authors taught residents about the care they provide and improved documented patient care.

Author Information

Dr. Houston is assistant professor of medicine, Divisions of General Internal Medicine and Preventive Medicine, University of Alabama at Birmingham School of Medicine; scientist, Deep South Center for Effectiveness Research, Birmingham VA Medical Center; and scientist, Center for Outcomes and Effectiveness Research, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

Dr. Wall is assistant professor of medicine, Division of General Pediatrics, University of Alabama at Birmingham School of Medicine; and scientist, Center for Outcomes and Effectiveness Research, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

Dr. Allison is associate professor of medicine, Divisions of General Internal Medicine and Preventive Medicine, University of Alabama at Birmingham School of Medicine; scientist, Deep South Center for Effectiveness Research, Birmingham VA Medical Center; and scientist, Center for Outcomes and Effectiveness Research, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

Dr. Palonen is assistant professor of medicine, Division of General Internal Medicine, University of Alabama at Birmingham School of Medicine; and scientist, Center for Outcomes and Effectiveness Research, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

Dr. Willett is assistant professor of medicine, Division of General Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

Dr. Kiefe is professor of medicine, Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine; director, Deep South Center for Effectiveness Research, Birmingham VA Medical Center; and co-director, Center for Outcomes and Effectiveness Research, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

Dr. Massie is assistant professor of medicine, Division of General Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

Dr. Benton is assistant professor of medicine, Division of General Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

Dr. Heudebert is associate professor of medicine, Division of General Internal Medicine, University of Alabama at Birmingham School of Medicine; and scientist, Center for Outcomes and Effectiveness Research, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

Please see the end of this report for information about the authors.

Correspondence should be addressed to Dr. Houston, 1530 Third Ave South, FOT 720, University of Alabama at Birmingham, Birmingham, AL 35294; telephone: (205) 934-7997; fax: (205) 975-7797; e-mail: (thouston@uab.edu).

© 2006 Association of American Medical Colleges