Audit and feedback and clinical practice guideline adherence: making feedback actionable.

Area of Science:

• Healthcare Management
• Quality Improvement
• Health Services Research

Background:

• Audit and feedback (A&F) is used to improve clinical practice guideline (CPG) adherence but its effectiveness varies.
• Research has not fully explored how feedback characteristics influence A&F effectiveness.
• This study examines differences in A&F data utilization between high and low performing facilities.

Purpose of the Study:

• To explore how high-performing facilities (HPF) and low-performing facilities (LPF) differ in their use of clinical audit data for feedback.
• To identify key characteristics of feedback that contribute to CPG adherence.

Main Methods:

• A descriptive, qualitative, cross-sectional study was conducted.
• Six Veterans Affairs Medical Centers (VAMCs) with high and low CPG adherence were purposefully sampled.
• Semi-structured interviews with 102 employees involved in CPG implementation were analyzed using grounded theory.

Main Results:

• HPF provided timely, individualized, and non-punitive feedback.
• LPF feedback was more variable in timeliness and non-punitiveness, relying on standardized, facility-level reports.
• Actionable feedback, characterized by timeliness, individualization, non-punitiveness, and customizability, emerged as a core concept.

Conclusions:

• Facilities with high CPG adherence deliver more timely, individualized, and non-punitive feedback.
• Feedback intervention characteristics appear to influence the effectiveness of A&F in changing provider behavior.
• Findings align with organizational research on the impact of feedback on desired behaviors.