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- H. Stephen Williams, MD, MPH*
- *Associate Professor of Pediatrics, College of Osteopathic Medicine, Michigan State University, Ann Arbor, Mich
Introduction
Our 12-member university pediatric group, mindful of the variables of practice and committed to thoughtful review, discussion, and consensus-seeking around available evidence, has taken advantage of the recognized need to develop and introduce into our practice an interactive process that promises to narrow variation in diagnostic and therapeutic approaches to common problems encountered in the office. This effort was designed to enhance efficiency and effectiveness of care, reduce confusion among patients and parents, promote recruitment and retention of families, and strengthen medical student and resident teaching. In this article, we share the process developed, results to date, and planned future applications. We also invite suggestions to strengthen the usefulness of this evolving process.
The Department of Pediatrics in the College of Osteopathic Medicine at Michigan State University maintains three private practice outpatient clinics and provides contractual services to three Ingham County Community Health Department sites. The 12 faculty members include 11 Board-certified pediatricians, both DOs and MDs, and 1 PhD nurse practitioner. Although some research is carried out, members are focused primarily on the teaching of medical students and residents and the delivery of care to patients. Experience of the participants in pediatrics after training varies from 1 to 30 years.
Extensive and difficult-to-defend variation in practice was identified initially in the landmark studies of John Wennberg at Dartmouth University. Physicians committed to evidence-based practice must integrate reproducible research-based findings regarding efficiency and effectiveness in diagnosis and treatment into clinical settings where experience and expertise vary widely and patient preferences must be respected. In terms of patients seen, time pressures experienced, patient expectations encountered, and financial challenges felt, our practice is no different from most general pediatric practices that teach students and residents. The author’s impression, after having been in this practice for nearly 1 year, was that the range …
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