HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Patel, M. R. Articles by Jollis, J. G. Search for Related Content PubMed PubMed Citation Articles by Patel, M. R. Articles by Jollis, J. G.

CLINICAL RESEARCH: MEDICAL EDUCATION

State-mandated continuing medical education and the use of proven therapies in patients with an acute myocardial infarction

Manesh R. Patel, MD^*,*, Trip J. Meine, MD^*, Jasmina Radeva, MA^*, Lesley Curtis, PhD^*, Sunil V. Rao, MD^*, Kevin A. Schulman, MD^* and James G. Jollis, MD^*

^* Duke Clinical Research Institute, Durham, North Carolina, USA
Division of Cardiology, Duke University, Durham, North Carolina, USA

Manuscript received December 5, 2003; revised manuscript received March 25, 2004, accepted March 30, 2004.

^* Reprint requests and correspondence: Dr. Manesh R. Patel, Duke Clinical Research Institute, PO Box 17969, Durham, North Carolina 27715, USA.
patel017{at}dcri.duke.edu

OBJECTIVES: The purpose of this study was to determine whether state-mandated continuing medical education (CME) requirements affect the use of evidence-based therapies and outcomes in patients with acute myocardial infarction (AMI).

BACKGROUND: The Institute of Medicine recommends that educational programs demonstrate their effect through process and outcome measures.

METHODS: We analyzed 134,609 patients according to whether or not CME was mandated in the state of physician practice. A hierarchical multivariable model was developed that controlled for state, hospital, physician, and patient level characteristics to determine the association between state CME requirements and the use of evidence-based therapies. Primary outcome measures were admission aspirin use and reperfusion therapy, and discharge aspirin and beta-blocker prescription. Thirty-day and one-year mortality were secondary outcome measures.

RESULTS: States with and without CME requirements had similar rates of aspirin use at admission and discharge (79.9% vs. 79.4% and 72.5% vs. 72.5%, respectively) and beta-blocker prescription at discharge (53.6% vs. 55.3%). The rate of reperfusion therapy at admission was significantly higher in states requiring CME (53.1%) compared with states without CME (47.9%) (p < 0.0001). After adjustment, patients admitted in CME-requiring states were significantly more likely to receive reperfusion therapy, mainly owing to "patented" thrombolytic therapy (odds ratio 1.15; p = 0.016). There was no association between CME requirements and one-year mortality.

CONCLUSIONS: State-mandated CME had little association with AMI care or outcome, other than an increased use of patented thrombolytic therapy. Further research is needed to maximize the measurable effect of CME on the use of proven therapies irrespective of whether patented or generic medications are involved.

Abbreviations and Acronyms   ACCME = Accreditation Council on Continuing Medical Education   AMI = acute myocardial infarction   CCP = Cooperative Cardiovascular Project   CME = continuing medical education   IOM = Institute of Medicine   OR = odds ratio

This article has been cited by other articles:

				S. John and J. E. Niederhuber Keeping Pace Oncologist, January 1, 2008; 13(1): 4 - 5. [Full Text] [PDF]

				A. E. Flanders What Is the Future of Electronic Learning in Radiology? RadioGraphics, March 1, 2007; 27(2): 559 - 561. [Full Text] [PDF]

				H. M. Krumholz The Year in Epidemiology, Health Services, and Outcomes Research J. Am. Coll. Cardiol., October 4, 2005; 46(7): 1362 - 1370. [Full Text] [PDF]