Abstract
BackgroundAudit and feedback (A&F) is a common quality improvement strategy with highly variable effects on patient care. It is unclear how A&F effectiveness can be maximised. Since the core mechanism of action of A&F depends on drawing attention to a discrepancy between actual and desired performance, we aimed to understand current and best practices in the choice of performance comparator.MethodsWe described current choices for performance comparators by conducting a secondary review of randomised trials of A&F interventions and identifying the associated mechanisms that might have implications for effective A&F by reviewing theories and empirical studies from a recent qualitative evidence synthesis.ResultsWe found across 146 trials that feedback recipients’ performance was most frequently compared against the performance of others (benchmarks; 60.3%). Other comparators included recipients’ own performance over time (trends; 9.6%) and target standards (explicit targets; 11.0%), and 13% of trials used a combination of these options. In studies featuring benchmarks, 42% compared against mean performance. Eight (5.5%) trials provided a rationale for using a specific comparator. We distilled mechanisms of each comparator from 12 behavioural theories, 5 randomised trials, and 42 qualitative A&F studies.ConclusionClinical performance comparators in published literature were poorly informed by theory and did not explicitly account for mechanisms reported in qualitative studies. Based on our review, we argue that there is considerable opportunity to improve the design of performance comparators by (1) providing tailored comparisons rather than benchmarking everyone against the mean, (2) limiting the amount of comparators being displayed while providing more comparative information upon request to balance the feedback’s credibility and actionability, (3) providing performance trends but not trends alone, and (4) encouraging feedback recipients to set personal, explicit targets guided by relevant information.
Highlights
Audit and feedback (A&F), a summary of clinical performance over a specified period of time, is one of the most widely applied quality improvement interventions inGude et al Implementation Science (2019) 14:39 area of uncertainty is the choice of performance comparator included in feedback reports. it is feasible to provide clinical performance feedback without an explicit comparison [7, 8], feedback is typically provided in the context of a performance comparator: a standard or benchmark to which the recipient’s observed performance level can be compared
In the ‘Results’ section, we presented the descriptions and frequency with which performance comparators have been used in randomised trials of A&F interventions, followed by the comparators’ mechanisms supported by theory and empirical evidence
We found that 98 of the 146 (67.1%) included A&F interventions used performance
Summary
Audit and feedback (A&F), a summary of clinical performance over a specified period of time, is one of the most widely applied quality improvement interventions inGude et al Implementation Science (2019) 14:39 area of uncertainty is the choice of performance comparator included in feedback reports. it is feasible to provide clinical performance feedback without an explicit comparison [7, 8], feedback is typically provided in the context of a performance comparator: a standard or benchmark to which the recipient’s observed performance level can be compared. Audit and feedback (A&F), a summary of clinical performance over a specified period of time, is one of the most widely applied quality improvement interventions in. Comparators play an important role in helping feedback recipients to identify discrepancies between current and desirable practice [9] and improve self-assessments [10]. The choice of comparator may have important implications for what message is conveyed by the feedback, and how recipients react to it [12]. Audit and feedback (A&F) is a common quality improvement strategy with highly variable effects on patient care. It is unclear how A&F effectiveness can be maximised. Since the core mechanism of action of A&F depends on drawing attention to a discrepancy between actual and desired performance, we aimed to understand current and best practices in the choice of performance comparator
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
