BACKGROUND: Community Acquired Pneumonia (CAP) was the second leading cause of morbidity in 1997 and third leading cause of mortality in the country for the year 1998. Due to the various management schemes for this disease, the Philippine Society of Microbiology and Infectious Diseases developed a Clinical Practice Guideline for the Evaluation and Management of Community Acquired Pneumonia in 1999. However, studies have shown that guidelines alone do not improve physician performance, therefore there is a need to explore other strategies for quality improvement.

OBJECTIVE: To determine whether a repeated individualized feedback on performance will improve the appropriateness of care delivered by first year residents to adult patients with Community Acquired Pneumonia seen at the Emergency Room (ER) of a tertiary hospital

SETTING: Emergency Room Section of the Philippine General Hospital.

SUBJECTS: The study subjects were first year residents for the year 2002.

DESIGN: Time series study.

INTERVENTION: Repeated individualized feedback on appropriateness of care given in both graphical and oral forms.

MAIN OUTCOME MEASURE: Comparison of the difference in before and after intervention percentage appropriateness of care in terms of seven criteria between repeated individualized feedback.

RESULTS: Mean age of the first year residents was 29.917 +/- 7.2796 years. Seven were males while five were females. Mean year graduated from medical school was 2.6667 +/- 1.7233 with a range of 1994 to 2000. From the seven criteria, three of them: Appropriateness of Diagnosis (96.7 percent), Complete Physical Examination (100 percent) and Laboratory Work-ups (96.7 percent), were already above the set standard of 80 percent during pre-intervention. With the repeated individualized feedback, the percentages of appropriateness of care for these criteria maintained above the set standard. At baseline, four of the criteria were noted to be below the set standard of 80 percent: Appropriateness of Care in Terms of Eliciting Co-morbidities (0.0 percent), Risk Stratification (75.8 percent), Treatment (43.3 percent) and Health Education (13.3 percent). These four parameters improved significantly but only two of them: Risk Stratification 100 percent, p 0.0065 and Treatment 90.5 percent, p 0.000, reached the set standard of at least 80 percent. For these two, the standards were reached after the second feedback. Appropriateness of Eliciting Comorbidities also improved significantly from 0 percent to 15.2 percent then 65.6 percent with a p value 0.0001 only after second feedback, even though the improvement was still below the set standard. Only appropriateness of Health Education did not improve further after second feedback (from 13.3 percent to 54.5 percent then 53.1 percent with a p value 0.0007) but still showed a trend towards increase.

CONCLUSION: Repeated individualized feedback as an intervention for quality improvement is an effective tool in improving performance, thus increasing quality to all aspects of care.

The Filipino Family Physician, 2003 41 ( 1 ) pages 14-23