Low rates of reporting commercial bias by physicians following online continuing medical education activities.

BACKGROUND: Concerns have been raised about bias in commercially supported continuing medical education (CME) activities, although the data are sparse about whether such bias exists, or if so, its extent. METHODS: Postactivity CME evaluation surveys were analyzed to quantitate reporting rates of bias, overall and by funding source. RESULTS: 5Of 1,621,647 physicians who participated in online CME activities, 1,064,642 (65.7%) completed the evaluation surveys and 5.9% reported no opinion. The affirmative rates of physician perception of bias were 0.63% overall, a weighted average of 0.84% for activities developed with and 0.48% for those developed without commercial support, a difference of 0.36% (P <.001, 95% confidence interval, 0.33-0.39). Among the subgroup who strongly disagreed that there is no bias, the difference between commercial (0.17%) and noncommercial (0.11%) funding was 0.06% (P <.001, 95% confidence interval, 0.05-0.08, P <.05), smaller than the overall difference. CONCLUSIONS: These data demonstrate that about 93% of physician participants affirmatively claim to perceive no commercial bias following online CME activities, over 99% if no opinion is included, overall and regardless of funding source.

A controlled trial of the effectiveness of internet continuing medical education.

BACKGROUND: The internet has had a strong impact on how physicians access information and on the development of continuing medical education activities. Evaluation of the effectiveness of these activities has lagged behind their development. METHODS: To determine the effectiveness of a group of 48 internet continuing medical education (CME) activities, case vignette surveys were administered to US physicians immediately following participation, and to a representative control group of non-participant physicians. Responses to case vignettes were analyzed based on evidence presented in the content of CME activities. An effect size for each activity was calculated using Cohen's d to determine the amount of difference between the two groups in the likelihood of making evidence-based clinical decisions, expressed as the percentage of non-overlap, between the two groups. Two formats were compared. RESULTS: In a sample of 5621 US physicians, of the more than 100,000 physicians who participated in 48 internet CME activities, the average effect size was 0.75, an increased likelihood of 45% that participants were making choices in response to clinical case vignettes based on clinical evidence. This likelihood was higher in interactive case-based activities, 51% (effect size 0.89), than for text-based clinical updates, 40% (effect size 0.63). Effectiveness was also higher among primary care physicians than specialists. CONCLUSION: Physicians who participated in selected internet CME activities were more likely to make evidence-based clinical choices than non-participants in response to clinical case vignettes. Internet CME activities show promise in offering a searchable, credible, available on-demand, high-impact source of CME for physicians.

Evaluating outpatient versus inpatient costs in endophthalmitis management.

PURPOSE: To assess the cost savings that would result from 1) implementing the treatment guidelines of the Endophthalmitis Vitrectomy Study (EVS) and 2) performing procedures on an outpatient rather than an inpatient basis, and to compare the savings to the cost of conducting the EVS. METHODS: The coding algorithms for four endophthalmitis treatment groups were obtained from Patient Financial Services at the Anne Bates Leach Eye Hospital (ABLEH) and national Medicare averages were consulted for reimbursements in 2000 dollars. The four groups were: 1) inpatient pars plana vitrectomy (PPV) with intravenous antibiotics; 2) outpatient PPV; 3) inpatient vitreous tap with intravenous antibiotics; and 4) outpatient vitreous tap. Physician reimbursements were calculated using International Classification of Diseases-9 (ICD-9) diagnoses and Current Procedural Terminology (CPT) codes. Facility reimbursements were calculated using ICD-9 diagnoses and Diagnosis-Related Group codes for inpatient procedures versus Ambulatory Payment Classification codes for outpatient procedures. The annual savings in reimbursements were estimated for a range of annual incidence rates of endophthalmitis assuming ABLEH financial data across all patients in the United States, and the savings into the future as well as the total expenses of conducting the EVS from 1989 to 1995 were summed in 2000 dollars using a net present value analysis based on the Bureau of Labor Statistics consumer price indices. RESULTS: Facility reimbursements are significantly higher for procedures performed on an inpatient compared to an outpatient basis (P < 0.001). Treating endophthalmitis according to the EVS guidelines on an outpatient basis would be associated with an estimated $1.5 to $7.8 million reduction in reimbursements per year. The cost of the EVS in 2000 dollars was $4.0 million. CONCLUSIONS: Implementing the treatment guidelines of the EVS on an outpatient basis may result in significant cost savings--savings that may cover the entire cost of the EVS in 3 years.