Improving Quality of Care Through Improved Audit and Feedback

背景资料。退伍军人管理局在衡量设施性能方面处于行业领先地位，这是 提高护理质量，投入大量资源开发和维持有效和具有成本效益的服务 措施。弗吉尼亚州的外部同行审查计划(EPRP)是监测设施的官方数据源 绩效，用于确定最需要关注的质量领域的优先顺序。设施性能 然而，衡量措施显著改善了预防和慢性护理以及整体质量， 在不同衡量标准的平均水平和改善水平上仍然存在很大的变异性 和设施。审计和反馈是有效绩效衡量的重要组成部分，可以 帮助减少这种变异性并提高整体绩效；校长之前的研究 研究人员建议，具有高EPRP性能分数的VAMC倾向于使用EPRP数据作为 反馈源。然而，EPRP数据被个人用作反馈源的方式 提供商以及服务线、设施和网络领导力还没有得到很好的理解。深入了解 理解所采用的心理模型、策略和具体的反馈过程特征 因此，迫切需要高性能的设施。 目标。这项研究探索了高绩效和低绩效设施的领导者 使用并反馈EPRP数据，以维护和改进其设施的性能。 方法：研究方法。对多达60次与初级保健、设施和 VISN在高、中、低性能设施的领导地位。我们将分析采访中的证据 不同设施对性能数据有用性的认知差异以及 传播评价业绩的业绩数据，特别注意及时性， 反馈传递的个人化、惩罚性。我们将在这个定性分析之后用一个网络- 基于对18个机构的初级保健人员的调查，以检查对EPRP数据的效用的看法 作为反馈源以及EPRP和其他数据源(如果有)的程度 以及时、个性化和非惩罚性的方式交付。

BACKGROUND. VA has lead the industry in measuring facility performance as a critical element to improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. VA's External Peer Review Program (EPRP) is the official data source for monitoring facility performance, used to prioritize the quality areas needing most attention. Facility performance measurement has significantly improved preventive and chronic care as well as overall quality, however, much variability still exists both in mean levels and improvement levels of performance across measures and facilities. Audit and feedback, an important component of effective performance measurement, can help reduce this variability and improve overall performance; previous research by the principal investigator suggests that VAMCs with high EPRP performance scores tend to use EPRP data as a feedback source. However, the manner in which EPRP data is used as a feedback source by individual providers as well as service line, facility, and network leadership is not well understood. An in-depth understanding of mental models, strategies, and specific feedback process characteristics adopted by high performing facilities is thus urgently needed. OBJECTIVE. This research explores specific ways in which leaders at high and low performing facilities use and feed back EPRP data to maintain and improve performance at their facilities. METHODS. Qualitative, grounded theory analysis of up to 60 interviews with primary care, facility and VISN leadership of high, moderate, and low performing facilities. We will analyze interviews for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness of feedback delivery. We will follow this qualitative analysis with a web- based survey of primary care personnel at 18 facilities to examine perceptions of the utility of EPRP data as a feedback source as well as the extent to which EPRP and other sources of data (if any) are delivered in a timely, individualized, and non-punitive manner.