Khan Tasneem, Alderson Sarah, Francis Jill J, Lorencatto Fabiana, Grant-Casey John, Stanworth Simon J, Foy Robbie
Leeds Institute for Health Sciences, University of Leeds, Leeds, UK.
School of Health Sciences, City University of London, London, UK.
Implement Sci Commun. 2020 Nov 25;1(1):106. doi: 10.1186/s43058-020-00089-3.
There is growing interest in the impact of national clinical audit programmes on the quality of healthcare. There is also an evolving evidence-base for enhancing the design and delivery of audit and feedback. We assessed the extent to which a sample of UK national clinical audit feedback reports met a set of good practice criteria over three time points.
We undertook three cross-sectional content analyses. We developed good practice criteria for the content and delivery of feedback based upon evidence, behavioural theory and expert opinion. We applied these to a feedback reports from 23 national audits listed on the Healthcare Quality Improvement Partnership (HQIP) website in November 2015. We repeated our assessments in January 2017 for 20 repeat feedback reports, after HQIP had published reporting guidance for national audits, and in August 2019 for a further 14 repeat feedback reports. We verified our assessments, where possible, with audit leads.
Feedback reports consistently included strengths at baseline, including past or planned repeated audit cycles (21; 91%), stating the importance of the topic in relation to patient care (22; 93%), using multi-modal data presentation (23; 100%), and summarising key findings (23; 100%). We observed improvements over subsequent assessments, so that by 2019, at least 13 out of 14 (93%) feedback reports presented easily identifiable key findings and recommendations, linked recommendations to audit standards, and proposed easily identifiable action plans. Whilst the use of regional comparators did not improve, audit leads highlighted that programmes now provide local data via additional means. The main shortcoming was the time lag between data collection and feedback; none of the 14 reports assessed in 2019 presented performance data less than 6 months old. Audit leads highlighted that some of these data might be available via programme websites.
We identified increased adherence to good practice in feedback by national clinical audit programmes that may enhance their impact on service delivery and outcomes. There is scope for improvement, especially in the recency of performance data. With further refinements, a criterion-based assessment offers an efficient means of monitoring the quality of national clinical audit feedback reports.
国家临床审计项目对医疗质量的影响正受到越来越多的关注。同时，关于改进审计及反馈的设计与实施，也有不断发展的证据基础。我们评估了英国国家临床审计反馈报告样本在三个时间点上符合一套良好实践标准的程度。
我们进行了三次横断面内容分析。我们基于证据、行为理论和专家意见，制定了反馈内容及传递方面的良好实践标准。我们将这些标准应用于2015年11月在医疗质量改进伙伴关系（HQIP）网站上列出的23项国家审计的反馈报告。在HQIP发布国家审计报告指南后，我们于2017年1月对20份重复反馈报告再次进行评估，并于2019年8月对另外14份重复反馈报告进行评估。我们尽可能与审计负责人核实我们的评估结果。
反馈报告在基线时始终包含优势，包括过去或计划中的重复审计周期（21份；91%）、说明该主题与患者护理相关的重要性（22份；93%）、使用多模式数据呈现（23份；100%）以及总结关键发现（23份；100%）。我们在后续评估中观察到了改进，到2019年，14份反馈报告中至少有13份（93%）呈现了易于识别的关键发现和建议，将建议与审计标准相联系，并提出了易于识别的行动计划。虽然区域比较指标的使用没有改进，但审计负责人强调，项目现在通过其他方式提供本地数据。主要缺点是数据收集和反馈之间的时间差；2019年评估的14份报告中，没有一份呈现的绩效数据少于6个月。审计负责人强调，其中一些数据可能可通过项目网站获取。
我们发现国家临床审计项目在反馈方面对良好实践的遵循有所增加，这可能会增强其对服务提供和结果的影响。仍有改进空间，特别是在绩效数据的时效性方面。通过进一步完善，基于标准的评估提供了一种监测国家临床审计反馈报告质量的有效方法。
