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Implementation Science
Published in: Implementation Science 1/2006

Open Access 01-12-2006 | Research article

Audit and feedback and clinical practice guideline adherence: Making feedback actionable

Authors: Sylvia J Hysong, Richard G Best, Jacqueline A Pugh

Published in: Implementation Science | Issue 1/2006

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Abstract

Background

As a strategy for improving clinical practice guideline (CPG) adherence, audit and feedback (A&F) has been found to be variably effective, yet A&F research has not investigated the impact of feedback characteristics on its effectiveness. This paper explores how high performing facilities (HPF) and low performing facilities (LPF) differ in the way they use clinical audit data for feedback purposes.

Method

Descriptive, qualitative, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low adherence to six CPGs, as measured by external chart review audits.
One-hundred and two employees involved with outpatient CPG implementation across the six facilities participated in one-hour semi-structured interviews where they discussed strategies, facilitators and barriers to implementing CPGs. Interviews were analyzed using techniques from the grounded theory method.

Results

High performers provided timely, individualized, non-punitive feedback to providers, whereas low performers were more variable in their timeliness and non-punitiveness and relied on more standardized, facility-level reports. The concept of actionable feedback emerged as the core category from the data, around which timeliness, individualization, non-punitiveness, and customizability can be hierarchically ordered.

Conclusion

Facilities with a successful record of guideline adherence tend to deliver more timely, individualized and non-punitive feedback to providers about their adherence than facilities with a poor record of guideline adherence. Consistent with findings from organizational research, feedback intervention characteristics may influence the feedback's effectiveness at changing desired behaviors.
Appendix
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Literature
1.
Harvey PA, Murphy MC, Dornom E, Berlowitz DJ, Lim WK, Jackson B: Implementing evidence-based guidelines:inpatient management of chronic obstructive pulmonary disease. Internal medicine journal. 2005, 35: 151-155. 10.1111/j.1445-5994.2004.00754.x.CrossRefPubMed
2.
Baker R, Falconer Smith J, Lambert PC: Randomised controlled trial of the effectiveness of feedback in improving test ordering in general practice. Scandinavian Journal of Primary Health Care. 2003, 21: 219-223. 10.1080/02813430310002995.CrossRefPubMed
3.
Eccles M, Steen N, Grimshaw J, Thomas L, McNamee P, Soutter J, Wilsdon J, Matowe L, Needham G, Gilbert F, Bond S: Effect of audit and feedback, and reminder messages on primary-care radiology referrals: a randomised trial. Lancet. 2001, 357: 1406-1409. 10.1016/S0140-6736(00)04564-5.CrossRefPubMed
4.
Goff DC, Massing MW, Bertoni AG, Davis J, Ambrosius WT, McArdle J, Duren-Winfield V, Sueta CA, Croft JB: Enhancing quality of heart failure care in managed Medicare and Medicaid in North Carolina: results of the North Carolina Achieving Cardiac Excellence (NC ACE) Project. American Heart Journal. 2005, 150: 717-724. 10.1016/j.ahj.2004.12.025.CrossRefPubMed
5.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment (Winchester, England). 2004, 8: iii-iiv.
6.
Jamtvedt G, Young JM, Kristoffersen DT, Thomson O'Brien MA, Oxman AD: Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2003
7.
Bordley WC, Chelminski A, Margolis PA, Kraus R, Szilagyi PG, Vann JJ: The effect of audit and feedback on immunization delivery: a systematic review. American Journal of Preventive Medicine. 2000, 18: 343-10.1016/S0749-3797(00)00126-4.CrossRefPubMed
8.
Foy R, Eccles MP, Jamtvedt G, Young J, Grimshaw JM, Baker R: What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review. BMC health services research. 2005, 5: 50-10.1186/1472-6963-5-50.CrossRefPubMedPubMedCentral
9.
Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD: Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006, CD000259-, 2
10.
11.
Stull MK: Performance feedback: a question of source credibility. The Journal of nursing administration. 1986, 16: 17-CrossRefPubMed
12.
Exworthy M, Wilkinson EK, McColl A, Moore M, Roderick P, Smith H, Gabbay J: The role of performance indicators in changing the autonomy of the general practice profession in the UK. Soc sci med. 2003, 56: 1493-504. 10.1016/S0277-9536(02)00151-X.CrossRefPubMed
13.
Bradley EH, Holmboe ES, Mattera JA, Roumanis SA, Radford MJ, Krumholz HM: Data feedback efforts in quality improvement: lessons learned from US hospitals. Quality & Safety in Health Care. 2004, 13: 26-31. 10.1136/qhc.13.1.26.CrossRef
14.
Vancouver JB, Tischner EC: The Effect of Feedback Sign on Task Performance Depends on Self-Concept Discrepancies. Journal of Applied Psychology. 2004, 89: 1092-1098. 10.1037/0021-9010.89.6.1092.CrossRefPubMed
15.
Kluger AN, DeNisi A: The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychological Bulletin. 1996, 119: 254-284. 10.1037/0033-2909.119.2.254.CrossRef
16.
Hysong S, Best R, Pugh J, Moore F: Not of One Mind: Mental Models of Clinical Practice Guidelines in the VA. Health Serv Res. 2005, 40: 829-847. 10.1111/j.1475-6773.2005.00387.x.CrossRefPubMedPubMedCentral
17.
Pugh JA: Knowledge management and clinical practice guideline implementation. [Final Report]. CPI 99129-1. 2001, San Antonio, TX, Veterans Evidence-Based Implementation Dissemination Center
18.
Strauss AL, Corbin J: Basics of qualitative research : techniques and procedures for developing grounded theory. 1998, Thousand Oaks, CA: Sage Publications, 2
19.
Glaser BG, Strauss AL: The Discovery of Grounded Theory. 1967, Chicago: Aldine Publishing Co
20.
Muhr T: Atlas. ti – Short User's Manual. [4.2 Build 061]. 2001, Berlin, Germany, Scientific Software Development
21.
Deshon RP, Kozlowski SWJ, Schmidt AM, Milner KR, Wiechmann D: A multiple-goal, multilevel model of feedback effects on the regulation of individual and team performance. Journal of Applied Psychology. 2004, 89: 1035-1056. 10.1037/0021-9010.89.6.1035.CrossRefPubMed
22.
Archer-Kath J, Johnson DW, Johnson RJ: Individual Versus Group Feedback in Cooperative Groups. Journal of Social Psychology. 1994, 134: 681-694.CrossRef
23.
Hauenstein NMA: Training Raters to Increase the Accuracy of Appraisals and the Usefulness of Feedback. Performance Appraisal: State of the Art in Practice. Edited by: Smither J. 1998, San Francisco: JOSSEY-BASS
24.
Nease AA, Mudgett B, Quinones MA: Relationships among feedback sign, self-efficacy, and acceptance of performance feedback. Journal of Applied Psychology. 1999, 84: 806-814. 10.1037/0021-9010.84.5.806.CrossRef
25.
Leung K, Su S, Morris MW: When is criticism not constructive? The roles of fairness perceptions and dispositional attributions in employee acceptance of critical supervisory feedback. Hum Relat. 2001, 54: 1155-1187.CrossRef
26.
Kinicki AJ, Prussia GE, Wu B, Kee-Ryan FM: A covariance structure analysis of employees' response to performance feedback. Journal of Applied Psychology. 2004, 89: 1057-1069. 10.1037/0021-9010.89.6.1057.CrossRefPubMed
27.
Lyons SS, Tripp-Reimer T, Sorofman BA, Dewitt JE, BootsMiller BJ, Vaughn TE, Doebbeling BN: VA QUERI Informatics Paper: Informatics technology for clinical guideline implementation: Perceptions of multiple stakeholders. J Am Med Inform Assoc. 2005, 12: 64-71. 10.1197/jamia.M1495.CrossRefPubMedPubMedCentral
28.
29.
Hysong SJ, Pugh JA, Best RG: Clinical Practice Guideline Implementation Patterns In VHA Outpatient Clinics. Health Services Research. 2006,
Metadata
Title
Audit and feedback and clinical practice guideline adherence: Making feedback actionable
Authors
Sylvia J Hysong
Richard G Best
Jacqueline A Pugh
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2006
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-1-9

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