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Improving quality of care through improved audit and feedback
Sylvia J Hysong1, Cayla R Teal, Myrna J Khan
1Houston VA Health Services Research & Development Center of Excellence, Michael E, DeBakey VA Medical Center, Houston, TX, USA. hysong@bcm.edu
Implementation Science : IS
|May 22, 2012
Summary
High-performing Veterans Affairs facilities effectively use External Peer Review Program (EPRP) data for quality improvement. Understanding their feedback strategies can enhance audit and feedback interventions for better healthcare quality across facilities.
Area of Science:
- Healthcare Quality Improvement
- Performance Measurement
- Health Services Research
Background:
- The Department of Veterans Affairs (VA) utilizes the External Peer Review Program (EPRP) to monitor facility performance and improve care quality.
- While performance measurement has enhanced care, significant variability persists across facilities and measures.
- Audit and feedback (A&F) interventions are crucial for reducing variability and improving performance, yet the specific strategies employed by high-performing facilities remain unclear.
Purpose of the Study:
- To compare how leaders at high, moderate, and low-performing VA Medical Centers (VAMCs) utilize EPRP clinical performance data.
- To understand the mental models, strategies, and feedback process characteristics adopted by high-performing VAMCs.
- To identify effective feedback elements and strategies for improving quality of care.
Main Methods:
- Qualitative, grounded theory analysis of up to 64 interviews.
- Sampling included primary care, facility, and Veterans Integrated Service Network (VISN) leadership from VAMCs with varying performance levels.
- Interviews analyzed for cross-facility differences in data perception, dissemination strategies, and feedback characteristics (timeliness, individualization, punitiveness).
Main Results:
- High-performing VAMCs tend to leverage EPRP data as a feedback source more effectively than lower-performing facilities.
- Specific strategies and characteristics of feedback processes in high-performing facilities are being identified.
- Differences in perceptions of performance data usefulness and dissemination strategies were observed across facility performance levels.
Conclusions:
- Effective feedback is essential for improving provider and facility performance.
- This research will illuminate key components of successful feedback strategies used by high-performing facilities.
- Findings will inform the development of more impactful A&F interventions to enhance healthcare quality.
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