title: What is needed to implement a web-based audit and feedback intervention with outreach visits to improve care quality: A concept mapping study among cardiac rehabilitation teams.
abstract: Evidence on successful quality improvement (QI) in health care requires quantitative information from randomized clinical trials (RCTs) on the effectiveness of QI interventions, but also qualitative information from professionals to understand factors influencing QI implementation.
  
  
  
  Using a structured qualitative approach, concept mapping, this study determines factors identified by cardiac rehabilitation (CR) teams on what is needed to successfully implement a web-based audit and feedback (A&F) intervention with outreach visits to improve the quality of CR care.
  
  
  
  Participants included 49 CR professionals from 18 Dutch CR centres who had worked with the A&F system during a RCT. In three focus group sessions participants formulated statements on factors needed to implement QI successfully. Subsequently, participants rated all statements for importance and feasibility and grouped them thematically. Multi dimensional scaling was used to produce a final concept map.
  
  
  
  Forty-two unique statements were formulated and grouped into five thematic clusters in the concept map. The cluster with the highest importance was QI team commitment, followed by organisational readiness, presence of an adequate A&F system, access to an external quality assessor, and future use and functionalities of the A&F system.
  
  
  
  Concept mapping appeared efficient and useful to understand contextual factors influencing QI implementation as perceived by healthcare teams. While presence of a web-based A&F system and external quality assessor were seen as instrumental for gaining insight into performance and formulating QI actions, QI team commitment and organisational readiness were perceived as essential to actually implement and carry out these actions. These two sociotechnical factors should be taken into account when implementing and evaluating the success of QI implementations in future research.
authors.affiliation: Department of Medical Informatics, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands. Electronic address: m.m.vanengen-verheul@amc.uva.nl.
authors.forename: Mariëtte M
authors.initials: MM
authors.lastname: van Engen-Verheul
authors.affiliation: MRC Health e-Research Centre, Institute of Population Health, University of Manchester, Manchester, UK. Electronic address: niels.peek@manchester.ac.uk.
authors.forename: Niels
authors.initials: N
authors.lastname: Peek
authors.affiliation: Department of General Practice, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: j.a.haafkens@amc.uva.nl.
authors.forename: Joke A
authors.initials: JA
authors.lastname: Haafkens
authors.affiliation: Department of Medical Informatics, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands. Electronic address: e.joukes@amc.uva.nl.
authors.forename: Erik
authors.initials: E
authors.lastname: Joukes
authors.affiliation: Department of Medical Informatics, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands. Electronic address: t.vromen@amc.uva.nl.
authors.forename: Tom
authors.initials: T
authors.lastname: Vromen
authors.affiliation: Department of Medical Informatics, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands. Electronic address: m.w.jaspers@amc.uva.nl.
authors.forename: Monique W M
authors.initials: MW
authors.lastname: Jaspers
authors.affiliation: Department of Medical Informatics, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands. Electronic address: n.f.keizer@amc.uva.nl.
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: de Keizer
mesh_terms: D000328:Adult; D000072038:Cardiac Rehabilitation / Q000592:standards*; D003210:Concept Formation; D005260:Female; D017144:Focus Groups; D000068156:Formative Feedback; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D016730:Program Development; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care
keywords: Cardiac rehabilitation; Concept mapping; Quality of health care