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A multicenter cluster randomized controlled trial of strategies to improve thyroid function testing
- Source :
- Medical care. 41(3)
- Publication Year :
- 2003
-
Abstract
- OBJECTIVES. This project aimed to compare the independent and combined effectiveness of two implementation interventions of guidelines for ordering thyroid function tests: a Memorandum Pocket Card (MPC) and a Test RequestForm (TRF). RESEARCH DESIGN. Intervention groups were wards. The study used an experimental 2*2 factorial design with matching hospitals according to size and activity and wards according to preintervention appropriateness for test ordering. Four ward groups were established: the dual intervention group, the order form group, the pocket card group and the control group. Physicians in all groups received guidelines and were invited to a local information meeting. MEASURES. The main outcome measure of effectiveness was the Guideline Conformity Rate (GCR). RESULTS. Six hospitals participated in the study (two middle-sized hospitals, two small-sized hospitals and two psychiatric hospitals). A total of 1412 orders for thyroid function tests were collected. GCR was 78% in the dual intervention group, 83% in the order form group, 73% in the pocket card group and 62% in the control group. The interaction between TRF and MPC was not significant (β = -0.70; P = 0.21). Compared with simple information, TRF was effective in increasing GCR (OR, 2.65; 95% CI, 1.52-4.62), unlike MPC (OR, 1.28; CI, 0.75-2.19). CONCLUSIONS. Using a robust design, our study shows the greater effectiveness of TRF than MPC and their association in implementing thyroid function test guidelines.
- Subjects :
- Research design
Adult
Male
medicine.medical_specialty
Pediatrics
Psychological intervention
Thyroid Function Tests
Unnecessary Procedures
Disease cluster
Thyroid function tests
law.invention
Feedback
Randomized controlled trial
law
Patients' Rooms
medicine
Humans
Aged
medicine.diagnostic_test
business.industry
Hospitals, Public
Public Health, Environmental and Occupational Health
Guideline
Middle Aged
Hospital Records
Test (assessment)
Practice Guidelines as Topic
Physical therapy
Female
Forms and Records Control
France
Guideline Adherence
Thyroid function
business
Total Quality Management
Subjects
Details
- ISSN :
- 00257079
- Volume :
- 41
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Medical care
- Accession number :
- edsair.doi.dedup.....44da4f8c9381b1cd3d15bdc3cddc2f54