PURPOSE: The purpose of this study is first to validate Case Policy Analysis as a measure of lipid screening and management practices in hypertensive patients. Secondly, the study proposes to develop and pilot an intervention based on case policy feedback as a means of modifying physician practice. OBJECTIVE""""""""S: The primary specific objectives are: (1) to determine the degree to which primary care physician clinical decision policies accurately reflect practice in screening and management of hypercholesterolemia in hypertensive patients; (2) to identify factors associated with differences in primary care physician decision policies and practice; and (3) to develop and pilot an educational intervention based on case policy feedback. A secondary objective is to describe primary care physician clinical decision policies and actual practice in a relatively small sample of physicians. RATIONALE: Appropriate identification and treatment of hypercholesterolemia in hypertensive patients is needed to significantly reduce their risk of coronary heart disease. Little is known about primary care physician cholesterol screening and management practices in hypertensive patients, the clinical decision policies which physicians apply in these patients, the factors determining these practices, and effective means of improving practice. In other contexts of medical care, educational interventions based on clinical decision policy feedback have been more effective in modifying practice behavior than more traditional educational interventions. DESIGN AND METHODS: With regard to the first two objectives, 78 physician practices will be randomly selected from two defined regions in the state of Washington, areas within a 75-mile radius of Seattle and Spokane, respectively. Physician practice, decision policies, knowledge, attitudes, risk preferences, and practice characteristics will be measured. Practice will be examined by medical record reviews and patient surveys of 40 hypertensive patients who were seen over the prior six months in each practice. The degree to which decision policies are correlated with practice, the determinants of policy and practice, and the content and variation of physician practice will be described. With regard to the third objective, 10 practices will be randomly selected the area within a 75 miles radius of Seattle. Subjects will receive an individualized decision policy feedback program plus knowledge-based education. Pre- and Post-intervention measurements of clinical policies, practice, and determinants of practice will be obtained. SIGNIFICANCE: The products will be an effective means of characterizing primary care physician lipid screening and management practices and policies in hypertensive patients and a piloted intervention based on case policy feedback.
