title: Computer-supported feedback message tailoring: theory-informed adaptation of clinical audit and feedback for learning and behavior change.
abstract: BACKGROUND
  Evidence shows that clinical audit and feedback can significantly improve compliance with desired practice, but it is unclear when and how it is effective. Audit and feedback is likely to be more effective when feedback messages can influence barriers to behavior change, but barriers to change differ across individual health-care providers, stemming from differences in providers' individual characteristics.
  
  
  CONCLUSIONS
  The purpose of this article is to invite debate and direct research attention towards a novel audit and feedback component that could enable interventions to adapt to barriers to behavior change for individual health-care providers: computer-supported tailoring of feedback messages. We argue that, by leveraging available clinical data, theory-informed knowledge about behavior change, and the knowledge of clinical supervisors or peers who deliver feedback messages, a software application that supports feedback message tailoring could improve feedback message relevance for barriers to behavior change, thereby increasing the effectiveness of audit and feedback interventions. We describe a prototype system that supports the provision of tailored feedback messages by generating a menu of graphical and textual messages with associated descriptions of targeted barriers to behavior change. Supervisors could use the menu to select messages based on their awareness of each feedback recipient's specific barriers to behavior change. We anticipate that such a system, if designed appropriately, could guide supervisors towards giving more effective feedback for health-care providers. A foundation of evidence and knowledge in related health research domains supports the development of feedback message tailoring systems for clinical audit and feedback. Creating and evaluating computer-supported feedback tailoring tools is a promising approach to improving the effectiveness of clinical audit and feedback.
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. zjl1@pitt.edu.
authors.forename: Zach
authors.initials: Z
authors.lastname: Landis-Lewis
authors.affiliation: Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, Ottawa, ON, Canada. jbrehaut@ohri.ca.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada. jbrehaut@ohri.ca.
authors.forename: Jamie C
authors.initials: JC
authors.lastname: Brehaut
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. harryh@pitt.edu.|Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA. harryh@pitt.edu.
authors.forename: Harry
authors.initials: H
authors.lastname: Hochheiser
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. gdouglas@pitt.edu.
authors.forename: Gerald P
authors.initials: GP
authors.lastname: Douglas
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. CROWLEYRS@upmc.edu.|Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA. CROWLEYRS@upmc.edu.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Jacobson
mesh_terms: D002983:Clinical Competence; D003194:Computer-Assisted Instruction / Q000379:methods; D005246:Feedback; D006801:Humans; D008485:Medical Audit / Q000379:methods*; D010820:Physicians; D058996:Quality Improvement