Women's College Hospital Institute for Health Systems Solutions and Virtual Care, 76 Grenville Ave Toronto, Toronto, Ontario, Canada.
Institute for Health Policy, Management & Evaluation, University of Toronto, 155 College St, Toronto, Ontario, Canada.
Implement Sci. 2021 Feb 17;16(1):19. doi: 10.1186/s13012-021-01088-1.
Audit and feedback (A&F) often successfully enhances health professionals' intentions to improve quality of care but does not consistently lead to practice changes. Recipients often cite data credibility and limited resources as barriers impeding their ability to act upon A&F, suggesting the intention-to-action gap manifests while recipients are interacting with their data. While attention has been paid to the role feedback and contextual variables play in contributing to (or impeding) success, we lack a nuanced understanding of how healthcare professionals interact with and process clinical performance data.
We used qualitative, semi-structured interviews guided by Normalization Process Theory (NPT). Questions explored the role of data in quality improvement, experiences with the A&F report, perceptions of the data, and interpretations and reflections. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using a combination of inductive and deductive strategies using reflexive thematic analysis informed by a constructivist paradigm.
Healthcare professional characteristics (individual quality improvement capabilities and beliefs about data) seem to influence engagement with A&F to a greater degree than feedback variables (i.e., delivered by peers) and observed contextual factors (i.e., strong quality improvement culture). Most participants lacked the capabilities to interpret practice-level data in an actionable way despite a motivation to engage meaningfully. Reasons for the intention-to-action gap included challenges interpreting longitudinal data, appreciating the nuances of common data sources, understanding how aggregate data provides insights into individualized care, and identifying practice-level actions to improve quality. These factors limited effective cognitive participation and collective action, as outlined in NPT.
A well-designed A&F intervention is necessary but not sufficient to inform practice changes. A&F initiatives must include co-interventions to address recipient characteristics (i.e., beliefs and capabilities) and context to optimize impact. Effective strategies to overcome the intention-to-action gap may include modelling how to use A&F to inform practice change, providing opportunities for social interaction relating to the A&F, and circulating examples of effective actions taken in response to A&F. More broadly, undergraduate medical education and post-graduate training must ensure physicians are equipped with QI capabilities, with an emphasis on the skills required to interpret and act on practice-level data.
审核和反馈（A&F）通常可以成功增强卫生专业人员改善医疗质量的意愿，但并不总能导致实践的改变。收件人经常提到数据可信度和有限资源是阻碍他们采取行动的障碍，这表明在收件人与其数据交互时，意图与行动之间存在差距。虽然已经关注到反馈和上下文变量在促成（或阻碍）成功方面的作用，但我们对医疗保健专业人员如何与临床绩效数据交互和处理数据缺乏细致的了解。
我们使用定性、半结构化访谈，以规范化进程理论（NPT）为指导。问题探讨了数据在质量改进中的作用、对 A&F 报告的经验、对数据的看法，以及解释和反思。访谈进行了录音，并逐字记录。使用归纳和演绎策略结合的方法分析数据，使用建构主义范式下的反思主题分析进行信息补充。
医疗保健专业人员的特征（个人质量改进能力和对数据的信念）似乎比反馈变量（即由同行提供）和观察到的上下文因素（即强大的质量改进文化）更能影响 A&F 的参与度。尽管大多数参与者有意愿进行有意义的参与，但他们缺乏以可操作的方式解释实践水平数据的能力。意图与行动之间存在差距的原因包括：解读纵向数据的挑战、理解常见数据源的细微差别、理解汇总数据如何为个性化护理提供见解，以及确定提高质量的实践水平行动。这些因素限制了有效的认知参与和集体行动，正如 NPT 所概述的那样。
精心设计的 A&F 干预措施是必要的，但不足以告知实践的改变。A&F 计划必须包括共同干预措施，以解决收件人的特征（即信念和能力）和背景，以优化影响。克服意图与行动之间差距的有效策略可能包括示范如何使用 A&F 来告知实践的改变，提供与 A&F 相关的社交互动机会，以及传播针对 A&F 采取的有效行动的例子。更广泛地说，本科医学教育和研究生培训必须确保医生具备质量改进能力，重点是解释和根据实践水平数据采取行动所需的技能。
