Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3096 — Participation of VA versus Non-VA Providers in the Multi-Site MI Plus Study

Tipton EF (Birmingham VA Medical Center) , Houston TK (University of Alabama School of Medicine), Funkhouser EM (University of Alabama, Birmingham School of Public Health), Levine DA (University of Alabama School of Medicine), Kiefe CI (University of Alabama School of Medicine)

Objectives:
The MI Plus study is a randomized, controlled trial of an Internet-delivered intervention to improve treatment of ambulatory post–myocardial infarction (MI) patients with multiple co-morbidities. In two parallel studies funded by NHLBI amd VA HSR&D, we recruited community-based Medicare providers in Alabama and Mississippi (NHLBI) and VA providers practicing in Community Based Outpatient Clinics (CBOCs) across the nation (VA HSR&D). This report compares VA and non-VA providers regarding recruitment and intensity of participation.

Methods:
The NHLBI study recruited community-based primary care physicians caring for post-MI patients using fax, postal and electronic mail, and telephone solicitation. Recruitment incentives for NHLBI recruits included a textbook, access to Elsevier online medical journals, and continuing medical education (CME) credits. The VA study recruited CBOC physicians by phone and fax using no incentives other than CME. The intervention arm for both studies will receive a 30-month Internet-based educational program, consisting of: 1) quarterly interactive cases on complex post-MI patients, 2) “literature watch” and 3) a “toolbox” with practice guidelines, treatment algorithms, and patient educational materials. We analyzed provider usage information obtained electronically by the website and compared enrollment for VA and non-VA physicians. Further, we compared intensity of participation by intervention providers (features accessed, cases completed, and number of visits to website) in the two groups.

Results:
Out of a pool of 2284 providers, 227 (9.8%) Alabama and Mississippi providers enrolled in the NHLBI study. Out of a pool of 699 VA CBOC providers, 328 (34%) from 267 CBOCs affiliated with 48 facilities enrolled in the VA study. Of providers randomized to the intervention arm (125 for VA, 108 for Medicare), a higher percentage of the VA providers accessed the literature watch (82.4% vs. 38.9%, p<0.001), completed at least 5 of the 6 cases (28.0% vs. 5.6%, p<0.001), and visited the website at least 10 times (22.4% vs. 7.4%, p=0.002).

Implications:
VA CBOC providers had higher enrollment in an Internet-based CME intervention than non-VA primary care physicians and VA providers made more intense use of the educational website.

Impacts:
Internet-based CME is attractive to CBOC physicians and may succeed in enhancing evidence-based care.