PARTNERING WITH PHYSICIANS TO ACHIEVE QUALITY IMPROVEMENT

Background: The Main Medical Assessment Foundation (MMAF) has successfully involved hundreds of Main physicians in study groups to analyze data on small-area variation and assess physician decision-making patterns. In 1991 the MMAF model was replicated across a tri-state area (Main, New Hampshire, Vermont) in an effort called the Outcomes Dissemination Project, which is funded by a five-year grant from the U.S. Agency for Health Care Policy and Research. The Outcomes Dissemination Project: Five specialty study groups, each meeting three times a year, examine local and national utilization data, examine guidelines and research findings, participate in outcomes studies and patient education, and disseminate their findings through specialty society presentations and other feedback efforts. The MMAF study group process is based on the beliefs that medicine is a subculture with a complex set of professional values, beliefs, socialization processes, and norms, and that qualify improvement efforts work best when they are nonpunitive and educational. Issues in obtaining physician involvement: (1) Physicians are willing to change their practices if they are brought into a culturally appropriate improvement program. (2) Related specialties (for example, internists and family practitioners) can often work together effectively on issues of common interest (3) Involving respected clinical leaders has helped establish the legitimacy of MMAF methods among physicians. (4) Area- and physicians-specific data are not made public, so as to build a sense of confidentiality among participants. Conclusions: The project continues to function as a powerful education process and serves as a model for replication elsewhere.