Yeung Gary Y C, Albers Charlotte A W, Smalbrugge Martin, de Bruijne Martine C, Jepma Patricia, Joling Karlijn J
Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands.
Aging & Later Life, Amsterdam Public Health, Amsterdam, the Netherlands.
BMC Health Serv Res. 2025 Feb 11;25(1):227. doi: 10.1186/s12913-025-12355-y.
Audit and group feedback (A&F) is an instrument used to encourage healthcare professionals to improve the quality of care. Clinical practice was audited against a set of criteria and fed back to a group by a facilitator. The aim of this study was to gain a better understanding of how physician group feedback sessions in nursing homes were conducted and to what extent they resulted in action planning.
Fifteen group feedback sessions of the antibiotic A&F program within a nursing home network were audio-recorded, transcribed, and analyzed via the Framework Method for thematic analysis. The coding was performed using the existing Calgary A&F Framework and Cooke's conceptual model of physician behaviors, and open inductive codes were added.
Elements of the conceptual model and the Calgary A&F Framework occurred within all group feedback sessions. The relationships within the group and with the facilitators were important elements when moving a group from interpreting the results to formulating action plans. Physician groups responded positively to the audit data, particularly if they were among the best performing. The data were met with doubt by physicians who did not recognize their own practice. When exploring potential reasons for lower guideline adherence, groups often considered data quality or external factors such as the choice of non-adherent treatment by locum staff. The degree of reflection on personal factors as explanations for low adherence and the extent to which groups identified learning and improvement opportunities varied: some groups were able to formulate action plans to address data problems and knowledge gaps, whereas others scheduled a follow-up meeting to develop action plans for treatment or prescribing practice changes.
The facilitator was crucial in supporting the group in interpreting the results, steering the conversation towards sharing change cues, and helping the physician group in developing action plans. The degree of reflection and action planning varied by group. By implementing the lessons learned from this study, group feedback sessions can be refined, supporting participants in action planning.
审核与小组反馈（A&F）是一种用于鼓励医疗保健专业人员提高护理质量的工具。根据一套标准对临床实践进行审核，并由一名协调员向一个小组反馈。本研究的目的是更好地了解疗养院中医生小组反馈会议是如何进行的，以及它们在多大程度上促成了行动计划的制定。
对疗养院网络内抗生素A&F项目的15次小组反馈会议进行了录音、转录，并通过主题分析的框架方法进行了分析。使用现有的卡尔加里A&F框架和库克医生行为概念模型进行编码，并添加了开放式归纳编码。
概念模型和卡尔加里A&F框架的要素出现在所有小组反馈会议中。当一个小组从解释结果转向制定行动计划时，小组内部以及与协调员之间的关系是重要因素。医生小组对审核数据反应积极，尤其是当他们属于表现最佳的小组时。不认可自己实践情况的医生对数据表示怀疑。在探究较低指南依从性的潜在原因时，小组通常会考虑数据质量或外部因素，如临时代理人员选择不依从治疗。对个人因素作为低依从性解释的反思程度以及小组识别学习和改进机会的程度各不相同：一些小组能够制定行动计划以解决数据问题和知识差距，而另一些小组则安排了后续会议来制定治疗或处方实践改变的行动计划。
协调员在支持小组解释结果、引导对话转向分享变革线索以及帮助医生小组制定行动计划方面至关重要。反思程度和行动计划因小组而异。通过实施从本研究中吸取的经验教训，可以完善小组反馈会议，支持参与者制定行动计划。
