Performance feedback: An exploratory study to examine the acceptability and impact for interdisciplinary primary care teams

Johnston, Sharon; Green, Michael E.; Thille, Patricia; Savage, Colleen; Roberts, Lynn; Russell, Grant; Hogg, William

doi:10.1186/1471-2296-12-14

Cited by 19 publications

(18 citation statements)

References 16 publications

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“…Yet, regardless of how carefully designed the intervention is, feedback cannot be effective if the intended recipient does not engage. Our findings build upon prior work in Ontario indicating that many physicians do not actively engage in existing A&F initiatives [ 30 – 34 ]. Immediate clinical tasks may take priority, and many physicians, whether working in teams or independently, are struggling to keep up rather than looking for ways to get ahead [ 35 ].…”

Section: Discussionsupporting

confidence: 82%

Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes

Ivers

Taljaard

Giannakeas

et al. 2020

Implement Sci Commun

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Background: Antipsychotic medication use in nursing homes is associated with potential for harms. In Ontario, Canada, an agency of the provincial government offers nursing home physicians quarterly audit and feedback on their antipsychotic prescribing. We compared the characteristics of physicians who did and did not engage with the intervention, and assessed early changes in prescribing. Methods: This population-level, retrospective cohort study used linked administrative databases to track prescribing practices in nursing homes pre-intervention (baseline), immediately post-initiative (3 months), and at follow-up (6 months). Exposure variables identified whether a physician signed up to participate (or not) or viewed the feedback following sign up (or not). Differences in the proportion of days that residents received antipsychotic medications at 6 months compared to baseline by exposure(s) were assessed using a linear mixed effects regression analysis to adjust for a range of resident, physician, and nursing home factors. Benzodiazepine and statin prescribing were assessed as a balance and tracer measures, respectively. Results: Of 944 eligible physicians, 210 (22.3%) signed up to recieve the feedback report and 132 (13.9%) viewed their feedback. Physicians who signed up for feedback were more likely to have graduated from a Canadian medical school, work in urban nursing homes, and care for a larger number of residents. The clinical and functional characteristics of residents were similar across physician exposure groups. At 6 months, antipsychotic prescribing had decreased in all exposure groups. Those who viewed their feedback report had a signicantly greater reduction in antipsychotic prescribing than those who did not sign up (0.94% patient-days exposed; 95% CI 0.35 to 1.54%, p = 0.002). Trends in prescribing patterns across exposure groups for benzodiazepines and statins were not statistically significant. Interpretation: Almost a quarter of eligible physicians engaged early in a voluntary audit and feedback intervention related to antipsychotic prescribing in nursing homes. Those who viewed their feedback achieved a small but statistically significant change in prescribing, equivalent to approximately 14,000 fewer days that nursing home residents received antipsychotic medications over 6 months. This study adds to the literature regarding the role of audit and feedback interventions to improve quality of care.

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Section: Discussionsupporting

confidence: 82%

Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes

Ivers

Taljaard

Giannakeas

et al. 2020

Implement Sci Commun

View full text Add to dashboard Cite

show abstract

“…At a practice level, Johnston et al observed that primary care teams were receptive of performance feedback and that team members thought that a feedback cycle could improve their organizational culture towards measurement and teamwork. However, findings also revealed that few teams or individuals understood how to use the data they received [ 33 ]. As a result, while many teams cited the promise of D2D’s future potential as a motivator to their participation, the same pressures and moderators may influence motivation to fully participate and eventually implement the A&F program.…”

Section: Discussionmentioning

confidence: 99%

Beyond quality improvement: exploring why primary care teams engage in a voluntary audit and feedback program

Wagner

Durbin

Barnsley

et al. 2017

BMC Health Serv Res

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BackgroundDespite its popularity, the effectiveness of audit and feedback in support quality improvement efforts is mixed. While audit and feedback-related research efforts have investigated issues relating to feedback design and delivery, little attention has been directed towards factors which motivate interest and engagement with feedback interventions. This study explored the motivating factors that drove primary care teams to participate in a voluntary audit and feedback initiative.MethodsInterviews were conducted with leaders of primary care teams who had participated in at least one iteration of the audit and feedback program. This intervention was developed by an organization which advocates for high-quality, team-based primary care in Ontario, Canada. Interview transcripts were coded using the Consolidated Framework for Implementation Research and the resulting framework was analyzed inductively to generate key themes.ResultsInterviews were completed with 25 individuals from 18 primary care teams across Ontario. The majority were Executive Directors (14), Physician leaders (3) and support staff for Quality Improvement (4). A range of motivations for participating in the audit and feedback program beyond quality improvement were emphasized. Primarily, informants believed that the program would eventually become a best-in-class audit and feedback initiative. This reflected concerns regarding existing initiatives in terms of the intervention components and intentions as well as the perception that an initiative by primary care, for primary care would better reflect their own goals and better support desired patient outcomes. Key enablers included perceived obligations to engage and provision of support for the work involved. No teams cited an evidence base for A&F as a motivating factor for participation.ConclusionsA range of motivating factors, beyond quality improvement, contributed to participation in the audit and feedback program. Findings from this study highlight that efforts to understand how and when the intervention works best cannot be limited to factors within developers’ control. Clinical teams may more readily engage with initiatives with the potential to address their own long-term system goals. Aligning motivations for participation with the goals of the audit and feedback initiative may facilitate both engagement and impact.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2765-3) contains supplementary material, which is available to authorized users.

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“…A previous study examining a quality improvement intervention in Ontario found that even multidisciplinary primary care teams failed to take action upon receiving feedback reports indicating substandard performance on chronic disease management due to a lack of “performance management skill development” [72]. At the same time, high-cost interventions are unlikely to be scalable or replicated.…”

Section: Methodsmentioning

confidence: 99%

Improving stroke prevention therapy for patients with atrial fibrillation in primary care: protocol for a pragmatic, cluster-randomized trial

et al. 2016

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BackgroundThe prevalence of atrial fibrillation (AF) is growing as the population ages, and at least 15% of ischemic strokes are attributed to AF. However, many high-risk AF patients are not offered guideline-recommended stroke prevention therapy due to a variety of system, provider, and patient-level barriers.MethodsWe will conduct a pragmatic, cluster-randomized controlled trial randomizing primary care clinics to test a “toolkit” of quality improvement interventions in primary care. In keeping with the recommendations of the chronic care model to simultaneously activate patients and facilitate proactive care by providers, the toolkit includes provider-focused strategies (education, audit and feedback, electronic decision support, and reminders) plus patient-directed strategies (educational letters and reminders). The trial will include two feedback cycles at baseline and approximately 6 months and a final data collection at approximately 12 months. The study will be powered to show a difference of 10% in the primary outcome of proportion of patients receiving guideline-recommended stroke prevention therapy. Analysis will follow the intention-to-treat principle and will be blind to treatment allocation. Unit of analysis will be the patient; models will use generalized estimating equations to account for clustering at the clinical level.DiscussionStroke prevention therapy using anticoagulation in patients with AF is known to reduce strokes by two thirds or more in clinical trials, but most studies indicate under-use of this treatment in real-world practice. If the toolkit successfully improves care for patients with AF, stakeholders will be engaged to facilitate broader application to maximize the potential to improve patient outcomes. The intervention toolkit tested in this project could also provide a model to improve quality of care for other chronic cardiovascular conditions managed in primary care.Trial registrationClinicalTrials.gov (NCT01927445). Registered August 14, 2014 at https://clinicaltrials.gov/.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0523-2) contains supplementary material, which is available to authorized users.

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Performance feedback: An exploratory study to examine the acceptability and impact for interdisciplinary primary care teams

Cited by 19 publications

References 16 publications

Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes

Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes

Beyond quality improvement: exploring why primary care teams engage in a voluntary audit and feedback program

Improving stroke prevention therapy for patients with atrial fibrillation in primary care: protocol for a pragmatic, cluster-randomized trial

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