Performance Summary Display Ontology: Feedback intervention content, delivery, and interpreted information

Feedback loops are vital for decision-making and behavior change in health systems, but not all feedback is of equal value. Clinical performance feedback to healthcare professionals and teams has potential for large effects on clinical practice, but evidence suggests that low-value performance feedback is widespread. A primary barrier to understanding the value of feedback loops in health systems may be a lack of a well-defined model and shared semantics for the information that they carry. An ontology for audit and feedback research may be used to address these issues by standardizing feedback intervention metadata. Research describing feedback interventions recognizes differences between the content of the feedback and its delivery process. However, terms describing feedback intervention content are inconsistent, and appear to vary considerably between audit and feedback frameworks, which can result in confusion around what is being delivered in a performance summary. Our objective was to develop an ontology of a performance summary in a clinical performance feedback intervention for the purposes of standardizing metadata. We developed the Performance Summary Display Ontology (PSDO) iteratively by 1) identifying terms for classes from behavior change theories relating to feedback interventions and cognitive theories of visualization, 2) searching for relevant existing ontologies and classes, and 3) using the terms to specify information content and visual displays in published examples of dashboard displays and feedback reports. PSDO is a lightweight application ontology that specifies performance information content and its representations for the purpose of feedback intervention research and evaluation. PSDO contains 3 primary domains: 1) Performance information content, based on constructs from behavior change theories, 2) Marks and their qualities, based on constructs from visualization theories, and 3) roles that link marks, information content, and other emergent characteristics, as interpreted information. PSDO may enable standardization of metadata for the study of feedback interventions.