Michael E. DeBakey VA Medical Center, Texas, USA.
3989 Baylor College of Medicine, Texas, USA.
Hum Factors. 2022 Feb;64(1):99-108. doi: 10.1177/00187208211005620. Epub 2021 Apr 8.
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.
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.
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 ( = 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.
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.
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.
Feedback in primary care has little standardization and does not follow available evidence for effective feedback design. Future research in this area is warranted.
本研究旨在揭示和分类在不同退伍军人事务部（VA）地点提供和传播临床绩效的各种实践，并根据文献中报告的基于证据的有效反馈模型评估其质量。
反馈可以提高后续绩效事件中的临床绩效。然而，有证据表明，反馈的提供方式决定了绩效是受到损害还是得到改善。
我们根据一组 17 项门诊临床绩效测量的高、低、始终中等和中等平均高度可变绩效，有目的地对 16 个地理位置分散的 VA 医院进行了抽样。我们排除了四个由于访谈数据不足的地点。我们从每个地点采访了四名关键人员（=48 人），以揭示有效的和无效的审计和反馈策略。访谈记录下来，并使用基于框架的内容分析方法进行定性分析，以确定出现的主题。
我们确定了 102 种用于提供反馈的独特策略。在这些策略中，根据审计和反馈研究文献，有 64 种（62.74%）被发现是无效的。比较有效（例如，个性化、计算机化的反馈报告）和无效（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，而获得最高效果评分的策略通过视觉理解的报告提供反馈，而不是在小组环境中进行。
研究结果表明，目前的实践主要利用了无效的反馈策略。未来的研究应该试图确定当前反馈和审计实践对临床绩效的长期影响。
初级保健中的反馈几乎没有标准化，也不符合有效反馈设计的可用证据。在该领域进行未来研究是必要的。
