ABSTRACT

Background: Educational interventions that yield measurable improvements in practice performance are needed, but research has not yet established which educational interventions yield measurably effective, financially feasible improvements in various specific contexts. Interventions designed to facilitate measurement  of improvement in practice performance have not been widely accepted by educators or learners.  

Method: To investigate challenges associated with the design, delivery, and use of interventions to measurably improve practice performance and patient out-  comes, we conducted a comprehensive review of 258 articles, including 96 evidence-based research studies exploring measurement of educational effect on prac-  tice performance or patient outcomes. We then reviewed 4 performance-improvement continuing medical education (PI CME) interventions designed to facilitate  improvement in practice performance among primary care physicians through baseline assessment, education, application, and subsequent reassessment.  

Results: For a variety of interventions, including traditional continuing education activities, data benchmarking, performance guidelines, provider performance  profiling, peer review, and patient chart audits, the use of individual interventions, educational and otherwise, has seldom produced measurably meaningful sus-  tainable effects on physician practice performance. Measurable improvement was sometimes shown, however, with the use of combined approaches in multiple  interventions over extended time periods. Some but not all of the factors shown to increase the impact of interventions have been incorporated into the PI CME  programs.  

Conclusion: Informational or educational interventions, when used alone, are unlikely to produce measurably meaningful, sustainable improvement in practice  performance. PI CME interventions advocated by medical specialty societies and examining boards because of their perceived potential for positively affecting per-  formance improvement, may be enhanced by incorporating some of the factors shown through research to increase the impact or sustainability of various interven-  tions. Barriers to development, delivery, and use of such interventions must be addressed to enhance their impact on the improvement of practice perforperformance.

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