The small group consensus process for changing physician practices: influenza vaccination.

OBJECTIVE. To evaluate the effectiveness of a small group consensus process in enhancing compliance with guidelines for influenza vaccination among older HMO members. DESIGN. A controlled study of the practice of primary care physicians, with pre/post comparisons and a 2-year follow-up. SETTING. An 84,000 member prepaid staff model HMO group practice. PARTICIPANTS. Primary care clinicians (N = 36) practicing in a staff model HMO. INTERVENTION. A small-group process, including opinion leader, feedback, and group decision making. MAIN OUTCOME MEASURE. Percentage of patients in a given physician-panel who received influenza immunization. RESULTS. Improvement in vaccination rate from 60.8% to 72.35% (with further increases over 2 successive years), in the intervention group as compared with improvement in the control from 60.7% to 65.93%. CONCLUSION. In this model, the small group consensus process resulted in an alteration in physician practice pattern, yielding a significant improvement in immunization rates above the already-established level of 60%.