With the growing use of ICBT in routine care clinics there is a need for literature on how to monitor and improve the quality of therapist behaviours in clinical practice. In this paper, we first provide background literature on Audit and Feedback (A&F), a common quality improvement technique, and then present a case study regarding the use of A&F to improve quality of therapist behaviours in emails sent to patients provided with ICBT in routine care. The A&F measure used was derived from previous research on therapist's email behaviours in ICBT. Fifteen undesirable therapist behaviours (e.g., Did Not Message, Unresponsive to Symptom Increase, Does Not Address Patient Concern) were audited in 1840 emails sent from eight therapists to 198 randomly selected patients, representing 18% of 1114 patients who started between one and five lessons of ICBT in the previous year and did not formally withdraw from treatment (n = 31 patients). The therapists who were audited were provided feedback four times over a one-year period from October 2018 to September 2019. Overall, in all audit periods, we found a low percentage of undesirable therapist behaviours (i.e., therapists displayed the behaviour in 12% or less of the total emails sent). For most therapist behaviours, we saw a trend towards improvement across the four audit cycles. Three therapist behaviours (i.e., Failure to Ask One Question to the Patient, Poor Instructions, Not Linking Email to Course Content) did not follow this pattern and were flagged for clinical discussion to determine why behaviours were elevated and whether these behaviours represented unrealistic expectations. The process was valuable for monitoring and improving therapist behaviours and highlights the need for future research on standards for therapist behaviours (e.g., which behaviours to focus on, setting acceptable levels of undesirable behaviour).

中文翻译：

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常规护理中治疗师辅助的互联网认知行为治疗的审核和反馈：质量改进案例研究。


随着 ICBT 在常规护理诊所中的使用越来越多，需要有关如何在临床实践中监测和提高治疗师行为质量的文献。在本文中，我们首先提供了审核和反馈 (A&F)（一种常见的质量改进技术）的背景文献，然后提出了一个关于使用 A&F 来提高发送给常规 ICBT 患者的电子邮件中的治疗师行为质量的案例研究关心。所使用的 A&F 测量源自之前对 ICBT 中治疗师的电子邮件行为的研究。在 8 名治疗师向 198 名随机选择的患者发送的 1840 封电子邮件中，审核了 15 种不良治疗师行为（例如，没有发消息、对症状增加无反应、没有解决患者的担忧），这些电子邮件占 1114 名开始一到五节课的患者的 18%前一年接受过 ICBT，但未正式退出治疗（n = 31 名患者）。接受审核的治疗师在 2018 年 10 月至 2019 年 9 月的一年时间内获得了四次反馈。总体而言，在所有审核期间，我们发现不良治疗师行为的比例较低（即，治疗师在 12% 或 12% 的比例中表现出不良行为）。少于发送的电子邮件总数）。对于大多数治疗师的行为，我们在四个审核周期中看到了改善的趋势。治疗师的三种行为（即未能向患者提出一个问题、指导不当、未将电子邮件与课程内容链接）没有遵循这一模式，并被标记为进行临床讨论，以确定行为为何升高以及这些行为是否代表了不切实际的期望。 这个过程对于监测和改善治疗师的行为很有价值，并强调了未来对治疗师行为标准进行研究的必要性（例如，要关注哪些行为，设定不良行为的可接受水平）。