Objective

The purpose of this study is to uncover and catalog the various practices for delivering and disseminating clinical performance in various Veterans Affairs (VA) locations and to evaluate their quality against evidence-based models of effective feedback as reported in the literature.

Background

Feedback can enhance clinical performance in subsequent performance episodes. However, evidence is clear that the way in which feedback is delivered determines whether performance is harmed or improved.

Method

We purposively sampled 16 geographically dispersed VA hospitals based on high, low, consistently moderate, and moderately average highly variable performance on a set of 17 outpatient clinical performance measures. We excluded four sites due to insufficient interview data. We interviewed four key personnel from each location (n = 48) to uncover effective and ineffective audit and feedback strategies. Interviews were transcribed and analyzed qualitatively using a framework-based content analysis approach to identify emergent themes.

Results

We identified 102 unique strategies used to deliver feedback. Of these strategies, 64 (62.74%) have been found to be ineffective according to the audit-and-feedback research literature. Comparing features common to effective (e.g., individually tailored, computerized feedback reports) versus ineffective (e.g., large staff meetings) strategies, most ineffective strategies delivered feedback in meetings, whereas strategies receiving the highest effectiveness scores delivered feedback via visually understood reports that did not occur in a group setting.

Conclusions

Findings show that current practices are leveraging largely ineffective feedback strategies. Future research should seek to identify the longitudinal impact of current feedback and audit practices on clinical performance.

Application

Feedback in primary care has little standardization and does not follow available evidence for effective feedback design. Future research in this area is warranted.

中文翻译：

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初级保健机构中有效审计和反馈实践的普遍性：退伍军人健康管理局内的定性检查

客观的

本研究的目的是揭示和分类在各个退伍军人事务部 (VA) 地点提供和传播临床表现的各种实践，并根据文献中报道的基于证据的有效反馈模型评估其质量。

背景

反馈可以提高后续表现阶段的临床表现。然而，有证据表明，提供反馈的方式决定了绩效是否受到损害或改善。

方法

我们有目的地对 16 家地理位置分散的 VA 医院进行抽样，这些医院基于 17 项门诊临床绩效指标的高、低、持续中等和中等平均高度可变的表现。由于访谈数据不足，我们排除了四个站点。我们采访了来自每个地点的四名关键人员 ( n = 48)，以发现有效和无效的审计和反馈策略。使用基于框架的内容分析方法对访谈进行转录和定性分析，以识别新兴主题。

结果

我们确定了 102 种用于提供反馈的独特策略。根据审计和反馈研究文献，在这些策略中，有 64 个（62.74%）被发现是无效的。比较有效（例如，单独定制的计算机化反馈报告）与无效（例如，大型员工会议）策略的共同特征，大多数无效策略在会议中提供反馈，而获得最高有效性分数的策略通过视觉理解的报告提供反馈，而没有发生在群体环境中。

结论

调查结果表明，目前的做法正在利用很大程度上无效的反馈策略。未来的研究应寻求确定当前反馈和审计实践对临床绩效的纵向影响。

应用

初级保健中的反馈几乎没有标准化，并且没有遵循有效反馈设计的现有证据。该领域的未来研究是有必要的。