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High-performing physicians are more likely to participate in a research study: findings from a quality improvement study.
BMC Med Res Methodol 2019; 19(1):171BM

Abstract

BACKGROUND

Participants in voluntary research present a different demographic profile than those who choose not to participate, affecting the generalizability of many studies. Efforts to evaluate these differences have faced challenges, as little information is available from non-participants. Leveraging data from a recent randomized controlled trial that used health administrative databases in a jurisdiction with universal medical coverage, we sought to compare the quality of care provided by participating and non-participating physicians prior to the program's implementation in order to assess whether participating physicians provided a higher baseline quality of care.

METHODS

We conducted clustered regression analyses of baseline data from provincial health administrative databases. Participants included all family physicians who were eligible to participate in the Improved Delivery of Cardiovascular Care (IDOCC) project, a quality improvement project rolled out in a geographically defined region in Ontario (Canada) between 2008 and 2011. We assessed 14 performance indicators representing measures of access, continuity, and recommended care for cancer screening and chronic disease management.

RESULTS

In unadjusted and patient-adjusted models, patients of IDOCC-participating physicians had higher continuity scores at the provider (Odds Ratio (OR) [95% confidence interval]: 1.06 [1.03-1.09]) and practice (1.06 [1.04-1.08]) level, lower risk of emergency room visits (Rate Ratio (RR): 0.93 [0.88-0.97]) and hospitalizations (RR:0.87 [0.77-0.99]), and were more likely to have received recommended diabetes tests (OR: 1.25 [1.06-1.49]) and cancer screening for cervical cancer (OR: 1.32 [1.08-1.61] and breast cancer (OR: 1.32 [1.19-1.46]) than patients of non-participating physicians. Some indicators remained statistically significant in the model after adjusting for provider factors.

CONCLUSIONS

Our study demonstrated a participation bias for several quality indicators. Physician characteristics can explain some of these differences. Other underlying physician or practice attributes also influence interest in participating in quality improvement initiatives and existing quality levels. The standard for addressing participation bias by controlling for basic physician and practice level variables is inadequate for ensuring that results are generalizable to primary care providers and practices.

Authors+Show Affiliations

CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, 113-43, rue Bruyère St, K1N 5C7, Annex E, Ottawa, ON, Canada. sdahrouge@bruyere.org. Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada. sdahrouge@bruyere.org. The Institute for Clinical evaluative Sciences, Ottawa, ON, Canada. sdahrouge@bruyere.org.Department of Economics, University of Ottawa, Ottawa, ON, Canada.CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, 113-43, rue Bruyère St, K1N 5C7, Annex E, Ottawa, ON, Canada. Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada. The Institute for Clinical evaluative Sciences, Ottawa, ON, Canada.CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, 113-43, rue Bruyère St, K1N 5C7, Annex E, Ottawa, ON, Canada. Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, 113-43, rue Bruyère St, K1N 5C7, Annex E, Ottawa, ON, Canada. Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31387540

Citation

Dahrouge, Simone, et al. "High-performing Physicians Are More Likely to Participate in a Research Study: Findings From a Quality Improvement Study." BMC Medical Research Methodology, vol. 19, no. 1, 2019, p. 171.
Dahrouge S, Armstrong CD, Hogg W, et al. High-performing physicians are more likely to participate in a research study: findings from a quality improvement study. BMC Med Res Methodol. 2019;19(1):171.
Dahrouge, S., Armstrong, C. D., Hogg, W., Singh, J., & Liddy, C. (2019). High-performing physicians are more likely to participate in a research study: findings from a quality improvement study. BMC Medical Research Methodology, 19(1), p. 171. doi:10.1186/s12874-019-0809-6.
Dahrouge S, et al. High-performing Physicians Are More Likely to Participate in a Research Study: Findings From a Quality Improvement Study. BMC Med Res Methodol. 2019 Aug 7;19(1):171. PubMed PMID: 31387540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-performing physicians are more likely to participate in a research study: findings from a quality improvement study. AU - Dahrouge,Simone, AU - Armstrong,Catherine Deri, AU - Hogg,William, AU - Singh,Jatinderpreet, AU - Liddy,Clare, Y1 - 2019/08/07/ PY - 2018/06/05/received PY - 2019/07/18/accepted PY - 2019/8/8/entrez PY - 2019/8/8/pubmed PY - 2019/8/8/medline KW - Primary care KW - Quality improvement KW - Research methods KW - Volunteer Bias SP - 171 EP - 171 JF - BMC medical research methodology JO - BMC Med Res Methodol VL - 19 IS - 1 N2 - BACKGROUND: Participants in voluntary research present a different demographic profile than those who choose not to participate, affecting the generalizability of many studies. Efforts to evaluate these differences have faced challenges, as little information is available from non-participants. Leveraging data from a recent randomized controlled trial that used health administrative databases in a jurisdiction with universal medical coverage, we sought to compare the quality of care provided by participating and non-participating physicians prior to the program's implementation in order to assess whether participating physicians provided a higher baseline quality of care. METHODS: We conducted clustered regression analyses of baseline data from provincial health administrative databases. Participants included all family physicians who were eligible to participate in the Improved Delivery of Cardiovascular Care (IDOCC) project, a quality improvement project rolled out in a geographically defined region in Ontario (Canada) between 2008 and 2011. We assessed 14 performance indicators representing measures of access, continuity, and recommended care for cancer screening and chronic disease management. RESULTS: In unadjusted and patient-adjusted models, patients of IDOCC-participating physicians had higher continuity scores at the provider (Odds Ratio (OR) [95% confidence interval]: 1.06 [1.03-1.09]) and practice (1.06 [1.04-1.08]) level, lower risk of emergency room visits (Rate Ratio (RR): 0.93 [0.88-0.97]) and hospitalizations (RR:0.87 [0.77-0.99]), and were more likely to have received recommended diabetes tests (OR: 1.25 [1.06-1.49]) and cancer screening for cervical cancer (OR: 1.32 [1.08-1.61] and breast cancer (OR: 1.32 [1.19-1.46]) than patients of non-participating physicians. Some indicators remained statistically significant in the model after adjusting for provider factors. CONCLUSIONS: Our study demonstrated a participation bias for several quality indicators. Physician characteristics can explain some of these differences. Other underlying physician or practice attributes also influence interest in participating in quality improvement initiatives and existing quality levels. The standard for addressing participation bias by controlling for basic physician and practice level variables is inadequate for ensuring that results are generalizable to primary care providers and practices. SN - 1471-2288 UR - https://www.unboundmedicine.com/medline/citation/31387540/High-performing_physicians_are_more_likely_to_participate_in_a_research_study:_findings_from_a_quality_improvement_study L2 - https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-019-0809-6 DB - PRIME DP - Unbound Medicine ER -