The 130th Annual Meeting of APHA

4053.0: Tuesday, November 12, 2002 - Board 7

Abstract #47275

Physicians Initiating Change: An Evidence Based Approach to Improving Patient Care

Kathleen McCain Murphy, Practice Enhancement for Physicians, Southern California Permanente Medical Group, 393 E. Walnut, Pasadena, CA 91103, (626) 685-5434,


Reducing physician practice variation through behavioral change has been studied extensively in health services literature. Decreasing variation is seen as one way to improve patient care through consistent application of treatment protocols. However, differences in education and medical training result in physicians having varying treatment methods with few opportunities to share methods or learn from each other. Approaches, such as academic detailing, have been successful in influencing change, however at significant cost, inconsistent results and typically, with physician resistance.

Data from this program will demonstrate effective methods of reducing variations in physician practices through the use of small physician work groups with a developmental educational approach complemented by facilitative and analytical support.


The Southern California Permanente Medical Group (SCPMG) implemented the Practice Enhancement for Physicians (PEP) project six years ago as a process to engage their physicians in a developmental approach to problem solving and sustaining change. This program provides an educational forum that allows physicians to review their existing practices, identify variations and initiate changes that impact care provided to Kaiser Permanente members. Similar yet distinct from CQI projects, the PEP model supports a physician-owned process that reflects conditions and concerns of the provider. Physicians participate in data driven discussions on the clinical appropriateness of a given medical approach, exam or treatment. Physicians identify topics of interest to their clinical practice, which range from HEDIS measures, such as mammography or immunization rates to operational issues, such as patient referral flow to industry concerns, such as reducing inappropriate antibiotic ordering.

Projects have been successfully replicated in with other physician groups and have demonstrated that this process can be implemented in a variety of sites, environments or medical disciplines. Monitoring of change rates also demonstrate that gains are sustained long term as a result of physician involvement in the change mechanism. The outcome of the program is proactive, educated choice rather than an external or administrative mandate towards change.

Learning Objectives: At the conclusion of this session, the participant will be able to

Keywords: Quality of Care, Change Concepts

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Southern California Permanente Medical Group Kaiser Permanente
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: I am employed by Kaiser Permanente

Medical Care Section Poster Session #3

The 130th Annual Meeting of APHA