Assessment of a Continuing Medical Education Intervention Designed to Change Physician Practice Regarding Blood Transfusion
Whicker, Shari A.
Dallas, A. Paul
Musick, David W.
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Background and Objectives: Excessive packed red blood cell (pRBC) transfusions are associated with worse clinical outcomes and unnecessary costs. While multi-faceted continuing medical education (CME) approaches have been shown to be effective methods for changing physician practice, few studies have evaluated this approach as a method for changing blood transfusion practices. Methods: In this prospective cohort study sought to use a multi-faceted CME platform to modify physician transfusion practices. In this prospective cohort study, the authors implemented a multi-faceted CME intervention including didactic presentations, distribution of educational materials, educational posters, and electronic medical record clinical decision support. Primary outcomes were number of pRBC transfusions prior to and after intervention and associated costs. Secondary outcomes included knowledge acquisition, satisfaction, self-reported improvement in knowledge, and intent to change behavior. The intervention targeted physicians from four departments: Surgery, Internal Medicine, Obstetrics and Gynecology, and Emergency Medicine. Results: Fifty-eight physicians participated in the experimental group and seventy-three physicians in the control group. There was a 26% decrease (P<.0001) in pRBC transfusions monthly when comparing the year prior to intervention to post-intervention year. Clinicians reported improved knowledge acquisition regarding transfusion risks and indications (P<.001). Adjusted transfusion practices saved the primary teaching hospital $722,950 following the intervention. Conclusion: This study supports the use of a multi-faceted CME intervention to align clinical practice with evidencebased transfusion guidelines. Future studies should investigate the effectiveness of individual components of multi-faceted CME interventions regarding improved physician knowledge and clinical practice, patient outcomes, and cost-benefit.