Effects of QI Interventions
QI interventions resulted in a statistically significant reduction in
rarely appropriate tests compared to the control group (OR 0.52, 95% CI
0.41-0.66; p<0.01) (Figure 2). The effects of QI interventions
were analyzed over both the short (< 3 months) and long-term
(> 3 months) with (OR 0.62, 95% CI: 0.49-0.79;
p<0.01) in the short term and (OR 0.47, 95% CI: 0.35-0.62;
p<0.01) in the long term (Figure 3). This suggests that the
introduction of a QI intervention resulted in both an immediate change
in provider ordering behavior to be more consistent with AUC guidelines,
with increasing effect over time. When we compared the odds ratios for
short-term and long-term follow-up, we found that there may be a trend
towards an increase in effect on long-term follow-up.
We also performed subgroup analysis of the type of QI intervention to
assess whether the effectiveness of QI intervention varied by modality.
Our analysis revealed that using either education tools or decision
support tools were both statistically significant in reducing rarely
appropriate testing (OR 0.54, 95% CI: 0.41-0.73; p<0.01; OR
0.47, 95% CI: 0.36-0.61; p<0.01) (Figure 4). Feedback tools
are often added to other QI intervention modalities due to the
assumption that it may augment the effect of QI interventions. Our
subgroup analysis showed that adding a feedback tool to either an
education tool or a decision support tool did not change the effect
compared to not using the feedback tool. The odds ratios for QI
intervention with or without a feedback tool added were similar and
demonstrated that QI interventions were effective at reducing rarely
appropriate testing even when used as the sole QI modality without
addition of a feedback tool (OR 0.49 vs. 0.57, 95% CI: 0.36-0.68 vs.
0.39-0.84; p>0.05) (Figure 5).