Measurement without management: qualitative evaluation of a voluntary audit & feedback intervention for primary care teams

BMC Health Services Research

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[1] 0000 0000 8793 5925, grid.155956.b, Centre for Addiction and Mental Health, 33 Russell Street, M5S 2S1, Toronto, Ontario, Canada;0000 0001 2157 2938, grid.17063.33, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada;0000 0001 2157 2938, grid.17063.33, Institute of Health Policy, Management and Evaluation, University of Toronto, Suite 425, 155 College Street, M5T 3M6, Toronto, Ontario, Canada;0000 0001 2157 2938, grid.17063.33, Institute of Health Policy, Management and Evaluation, University of Toronto, Suite 425, 155 College Street, M5T 3M6, Toronto, Ontario, Canada;0000 0001 2157 2938, grid.17063.33, Department of Family and Communtiy Medicine, University of Toronto, Toronto, Ontario, Canada;0000 0004 0474 0188, grid.417199.3, Family Practice Health Centre, Institute for Health Systems Solutions and Women’s College Hospital Research Institute, Women’s College Hospital, 76 Grenville Street, M5S 1B2, Toronto, Ontario, Canada;0000 0004 1936 7697, grid.22072.35, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6, Calgary, Alberta, Canada;

关键词: Audit and feedback;    Quality improvement;    Implementation;    Performance measurement;    Primary care;   

DOI  :  10.1186/s12913-019-4226-7

来源: publisher

【 摘 要 】

BackgroundThe use of clinical performance feedback to support quality improvement (QI) activities is based on the sound rationale that measurement is necessary to improve quality of care. However, concerns persist about the reliability of this strategy, known as Audit and Feedback (A&F) to support QI. If successfully implemented, A&F should reflect an iterative, self-regulating QI process. Whether and how real-world A&F initiatives result in this type of feedback loop are scarcely reported. This study aimed to identify barriers or facilitators to implementation in a team-based primary care context.MethodsSemi-structured interviews were conducted with key informants from team-based primary care practices in Ontario, Canada. At the time of data collection, practices could have received up to three iterations of the voluntary A&F initiative. Interviews explored whether, how, and why practices used the feedback to guide their QI activities. The Consolidated Framework for Implementation Research was used to code transcripts and the resulting frameworks were analyzed inductively to generate key themes.ResultsTwenty-five individuals representing 18 primary care teams participated in the study. Analysis of how the A&F intervention was used revealed that implementation reflected an incomplete feedback loop. Participation was facilitated by the reliance on an external resource to facilitate the practice audit. The frequency of feedback, concerns with data validity, the design of the feedback report, the resource requirements to participate, and the team relationship were all identified as barriers to implementation of A&F.ConclusionsThe implementation of a real-world, voluntary A&F initiative did not lead to desired QI activities despite substantial investments in performance measurement. In small primary care teams, it may take long periods of time to develop capacity for QI and future evaluations may reveal shifts in the implementation state of the initiative. Findings from the present study demonstrate that the potential mechanism of action of A&F may be deceptively clear; in practice, moving from measurement to action can be complex.

【 授权许可】

CC BY