Outcome measurement in multi-interventional continuing medical education

Approaches to outcome determination for multi-interventional continuing medical education (CME) are described using, as a case example, community-wide CME interventions to increase primary care physician adherence to national guidelines for breast cancer screening. The sources and types of data that can be used for outcome determination are reviewed and baseline measures for needs assessment are provided. The example ofpreinter-vention and postintervention surveys of primary care physicians and women demonstrates a methodology for determining changes in breast cancer screening practices and barriers to screening. The multimethod “package” of interventions used in the case example included formal CME conferences, a physician newsletter, breast examination skills training, a breast cancer CME monograph, a “question of the month” at hospital staff meetings, and primary care office visits. The outcome measures demonstrated that physicians practicing in the CME intervention towns had a significant increase in the number of reported mammography referrals of asymptomatic women aged 50 to 75 years (33% preintervention to 53% postintervention). Changes in the CME control town were smaller and not statistically significant for the sample size available. There were no significant increases in reported performance of breast examination. The multi-interventional CME methods can be used for many other content areas. The specified outcome measures can be collected through surveys and/or chart review and include all levels within the hierarchy of evaluation data. Surveying physicians at community hospital department meetings was a cost-effective approach to obtaining good survey response rates. Multi-interventional CME is a feasible method to increase community physician adherence to mammography screening guidelines.