Are Differences in Practitioners' Acceptance of a Quality Assurance Intervention Related to Their Performance?

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Abstract
The authors assessed whether practitioners' attitudes toward quality assurance after the intervention are related to their performance before and after the intervention. A data base was compiled including a survey of practitioners participating in a randomized, controlled trial of externally coordinated quality assurance in 16 practices. The survey evaluated whether practitioners noticed changes in their performance or improvements in care as a result of the external review and whether they preferred internal review or external review that promoted practitioner input and a collegial atmosphere. Practitioners' differences in accepting quality interventions related to quality improvement. A minority of practitioners believed that they had changed their practice or that care had improved in response to quality assurance; these options were not associated with actual performance. Many practitioners approved of internal quality assurance; however, most preferred external review. A few totally disagreed with quality assurance. Greater approval of externally coordinated review was marginally associated with worse baseline performance and significantly associated with better postintervention performance. This relationship was reversed for internal review. It is commonly perceived that practitioners resent external quality assurance. Our results show the opposite. These findings predict practitioner acceptance for a mode of quality assurance now widely used.