Inside the Black Box of Audit and Feedback: a Laboratory Study to Explore Determinants of Improvement Target Selection by Healthcare Professionals in Cardiac Rehabilitation.
Audit and feedback (A&amp;F) is widely used to aid healthcare professionals in improving clinical performance, but there is little understanding of the underlying mechanism that determines its effectiveness. The aim of this paper is to investigate the process by which healthcare professionals select indicators as improvement targets based on A&amp;F. We performed a laboratory study among 41 healthcare professionals in the context of a web-based A&amp;F intervention designed to improve the quality of cardiac rehabilitation care in the Netherlands. Feedback was provided on eighteen quality indicators, including a score and a colour (representing a recommendation for selection (red and yellow) or non-selection (green)). Indicators with more room for improvement were more likely to be selected, although this varied substantially between participants. In more than a quarter of the cases, participants did not select indicators with obvious room for improvement (yellow or red colour), or selected indicators without apparent room for improvement (green colour). We conclude that personal preferences and beliefs concerning quality and performance targets may dilute the efficiency of A&amp;F.
Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands.
Wouter T
WT
Gude
Health e-Research Centre, Institute of Population Health, University of Manchester, United Kingdom.
Sabine N
SN
van der Veer
Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands.
Mariëtte M
MM
van Engen-Verheul
Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands.
Nicolette F
NF
de Keizer
Health e-Research Centre, Institute of Population Health, University of Manchester, United Kingdom.
Niels
N
Peek
D020000:Decision Support Systems, Clinical / Q000458:organization & administration; D000068156:Formative Feedback; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D008485:Medical Audit / Q000458:organization & administration*; D017146:Models, Organizational; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D012046:Rehabilitation / Q000592:standards