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).