The Impact of the ABIM's Practice Improvement Modules on Patient Outcomes

摘要

In the article titled, "Improving Asthma Care Through Recertification: A Cluster Randomized Trial," the authors argue in the "Comment" section that their findings "provide the first evidence" that the recertification requirements of the American Board of Internal Medicine (ABIM) "may improve relevant disease outcomes." However, the authors base this statement on a post hoc analysis of a highly selected subsample (patients assigned to physicians who fully completed the ABIM's asthma practice improvement module [PIM]) using an "end point" that was not specified at the time they registered their clinical trial. Even then, the so-called improvement was of questionableclinical significance. Using a more appropriate intention-to-treatanalysis that compared the patients of physicians assigned to usual practice or to the completion of the PIM, the authors found no clinically important or statistically significant difference in their primary outcome (ie, percentage of physicians' patients filling an inhaled corti-costeroid prescription); nor was there a difference in patient's self-reported asthma severity when the appropriate analysis was used.