Limitations of CQI Scientific Research

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Limitations of CQI Scientific Research

• William E. Golden, MD FACP
• Professor Of Medicine, UAMS
• Past President, AHQA
• PCC, Arkansas Foundation for Medical Care

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HCQIP - Challenges

• Efficient Project Dissemination
• Motivating Local Project Adoption
• Effecting Local Behavior Change
• Multiple Projects at Multiple Sites
• Measuring Impact of Projects
• Measuring Impact of Interventions

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COOPERATIVE CARDIOVASCULAR PROJECT
Aspirin Given At Discharge
Beta Blockers Given At Discharge
Timing Of Aspirin
Aspirin Given
INDICATORS
P-Valuelt.01
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Changing Clinical Behavior

• Exposure, Learning, Clinical Change
• What Motivates Change?
• What Methods are Effective, Efficient?
• Local Education, Ownership of Project

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MetaAnalyses

• Rand, CDC - Prevention Study
• Literature Not Robust
• Mulitple Interventions Better

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CQI Research

• Targets
• Providers
• Institutions
• Patients
• Interventions (Macro, Micro)
• Efficacy vs Effectiveness Assessment
• Process vs Outcome
• Environmental Factors

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Barriers

• Control Groups
• Contamination
• Hawthorne Effect
• Secular Trends
• Statistical Power
• Generalizability

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CQI Methods Research

• Small Target, Limited Sites (Efficacy?)
• Control of Variables
• Limited Generalizability
• Community Projects (Effectiveness?)
• Contamination, Secular Trends
• Control Group Differences

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HRSA Asthma Project

• Different Interventions in Regions
• What is Unit of Measure
• Change in Provider Behavior
• Need s of Providers with s of Patients
• Formative Analysis vs Outcomes

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Public Education

• Focus Groups
• Exposure Data
• Measuring Impact of Materials
• Awareness vs Motivation
• Measuring Behavior Change
• Secular Trends

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Wish List

• Methodology Summit
• CQI- Research Community Dialogue
• What is Needed vs What Can be Funded
• Efficacy vs Effectiveness in CQI Research
• Assessing Community Interventions
• Emphasis on Portability, Efficiency
• Minimal Criteria for Credibility
• Controls, Power, Timeframe