title: Computer-Supported Feedback Message Tailoring for Healthcare Providers in Malawi: Proof-of-Concept.
abstract: Although performance feedback has the potential to help clinicians improve the quality and safety of care, healthcare organizations generally lack knowledge about how this guidance is best provided. In low-resource settings, tools for theory-informed feedback tailoring may enhance limited clinical supervision resources. Our objectives were to establish proof-of-concept for computer-supported feedback message tailoring in Malawi, Africa. We conducted this research in five stages: clinical performance measurement, modeling the influence of feedback on antiretroviral therapy (ART) performance, creating a rule-based message tailoring process, generating tailored messages for recipients, and finally analysis of performance and message tailoring data. We retrospectively generated tailored messages for 7,448 monthly performance reports from 11 ART clinics. We found that tailored feedback could be routinely generated for four guideline-based performance indicators, with 35% of reports having messages prioritized to optimize the effect of feedback. This research establishes proof-of-concept for a novel approach to improving the use of clinical performance feedback in low-resource settings and suggests possible directions for prospective evaluations comparing alternative designs of feedback messages.
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Zach
authors.initials: Z
authors.lastname: Landis-Lewis
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA.
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, Pittsburgh, PA.
authors.forename: Harry
authors.initials: H
authors.lastname: Hochheiser
authors.affiliation: Google, New York, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kam
authors.affiliation: Baobab Health Trust, Lilongwe, Malawi.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gadabu
authors.affiliation: Baobab Health Trust, Lilongwe, Malawi.
authors.forename: Mwatha
authors.initials: M
authors.lastname: Bwanali
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Jacobson
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003201:Computers; D057286:Electronic Health Records; D004650:Employee Performance Appraisal; D005246:Feedback; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy; D006282:Health Personnel; D006779:Hospitals, Public; D006801:Humans; D008295:Malawi; D010044:Outpatient Clinics, Hospital; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents