Abstract
Background/Aims To assess the impact of personalized physician learning (PPL) interventions using simulated learning cases on control of hypertension and dyslipidemias in primary care settings.
Methods One hundred thirty-two primary care physicians (PCP) with their 6307 patients with uncontrolled HT and their 20,030 patients with uncontrolled dyslipidemia were cluster randomized to one of three conditions: (a) no intervention, (b) PPL-EMR intervention in which 12 personalized learning cases were assigned to each PCP based on observed patterns of care in the electronic medical record (EMR) in the prior 1-year period, or (c) PPL-ASSESS intervention in which 12 personalized learning cases were assigned based on PCP performance on 4 standardized assessment cases. General and generalized linear mixed models were used to account for clustering and to model differences in actual patient outcomes across study arms.
Results Among those with uncontrolled HT at baseline, 49.1%, 46.6% and 47.3% (P = 0.43) achieved BP targets at follow-up, and among those with uncontrolled dyslipidemia at baseline, 37.5%, 37.3% and 38.1% (P = 0.72) achieved LDL targets at follow-up in PPL-EMR, PPL-ASSESS, and the control group, respectively. Although both SBP (P <.001) and lipid (P <.001) values significantly improved during the study period, the group x time interaction term showed no significant differential change in SBP values (P = 0.51) or lipid values (P = 0.61) across the 3 study arms. No difference in intervention effect was noted when comparing the PPL-EMR and the PPL-ASSESS interventions (P = 0.47).
Conclusions The two personalized physician learning interventions tested in this study did not lead to improved control of hypertension or dyslipidemia in primary care clinics during a mean 14-month follow-up period. This null result may have been due in part to substantial improvement in BP and lipid control in all study site patients during the study period.
