Improving quality of care. A systematic review on how medical registries provide information feedback to health care providers

Veer, Sabine N van der; Keizer, Nicolette F. de; Ravelli, Anita C.J.; Tenkink, Suzanne; Jager, Kitty J.

doi:10.1016/j.ijmedinf.2010.01.011

Cited by 154 publications

(181 citation statements)

References 59 publications

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“…Evidence from a systematic review 176 and a study 177 examining private feedback suggest that it can motivate providers to respond through raising awareness of performance in relation to peers and through peer competition. Evidence from studies comparing private and public reporting 35,39,118,179 suggests that while clinicians are intrinsically motivated to maintain good patient care, the public reporting of performance places additional pressure on them to take steps to improve patient care, particularly for poor performers.…”

Section: Theorymentioning

confidence: 99%

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

174

263

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BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Theorymentioning

confidence: 99%

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

174

263

View full text Add to dashboard Cite

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“…In a systematic review on how medical registers provide information feedback, van der Veer at al. 1 found limited and varying effects of QA registers and identified a series of barriers to be addressed to improve success, like lack of trust in the data (e.g. the 'we have sicker patients' syndrome), lack of motivation and organisational constraints.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are conflicting results regarding the effectiveness of such feedback. [1][2][3][4][5] Quality assurance (QA) of flexible gastrointestinal endoscopy services has been recommended. 1,6 In Norway, a national QA programme for colonoscopy was implemented in 2003 -the Gastronet programme.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] Quality assurance (QA) of flexible gastrointestinal endoscopy services has been recommended. 1,6 In Norway, a national QA programme for colonoscopy was implemented in 2003 -the Gastronet programme. 1,7 This programme provides annual feedback of performance indicators to individual endoscopists and endoscopy centres.…”

Section: Introductionmentioning

confidence: 99%

“…1,6 In Norway, a national QA programme for colonoscopy was implemented in 2003 -the Gastronet programme. 1,7 This programme provides annual feedback of performance indicators to individual endoscopists and endoscopy centres. Improvement of standards remains the responsibility of each centre and the individual endoscopist, but is encouraged through network meetings within the Gastronet programme.…”

Section: Introductionmentioning

confidence: 99%

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Time trends in quality indicators of colonoscopy

et al. 2016

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Background: There is considerable variation in the quality of colonoscopy performance. The Norwegian quality assurance programme Gastronet registers outpatient colonoscopies performed in Norwegian endoscopy centres. The aim of Gastronet is long-term improvement of endoscopist and centre performance by annual feedback of performance data. Objective: The objective of this article is to perform an analysis of trends of quality indicators for colonoscopy in Gastronet.Methods: This prospective cohort study included 73,522 outpatient colonoscopies from 73 endoscopists at 25 endoscopy centres from 2003 to 2012. We used multivariate logistic regression with adjustment for relevant variables to determine annual trends of three performance indicators: caecum intubation rate, pain during the procedure, and detection rate of polyps 5 mm. Results: The proportion of severely painful colonoscopies decreased from 14.8% to 9.2% (relative risk reduction of 38%; OR ¼ 0.92 per year in Gastronet; 95% CI 0.86-1.00; p ¼ 0.045). Caecal intubation (OR ¼ 0.99; 95% CI 0.94-1.04; p ¼ 0.6) and polyp detection (OR ¼ 1.03; 95% CI 0.99-1.07; p ¼ 0.15) remained unchanged during the study period. Conclusions: Pain at colonoscopy showed a significant decrease during years of Gastronet participation while caecal intubation and polyp detection remained unchanged -independent of the use of sedation and/or analgesics and level of endoscopist experience. This may be due to the Gastronet audit, but effects of improved endoscopy technology cannot be excluded.

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