Improving Quality of Care Through Improved Audit and Feedback

背景VA在测量设施性能方面处于行业领先地位， 提高护理质量，投入大量资源，以发展和维持有效和具有成本效益的 措施VA的外部同行评审计划（EPRP）是监测设施的官方数据来源 性能，用于优先考虑最需要关注的质量领域。设施性能 测量显著改善了预防和慢性病护理以及总体质量，然而， 各指标的平均水平和改进水平仍然存在很大的差异 和设施。审计和反馈是有效业绩衡量的重要组成部分， 有助于减少这种变化，提高整体性能;以前的研究，由校长 研究者认为，EPRP表现得分高的VAMC倾向于使用EPRP数据作为评估 反馈源然而，EPRP数据被个人用作反馈源的方式 供应商以及服务线、设施和网络领导力没有得到很好的理解。深入 理解心理模型，策略和具体的反馈过程特征， 因此，迫切需要高性能的设施。 OBJECTIVE.这项研究探讨了高绩效和低绩效设施的领导者 使用和反馈EPRP数据，以维护和提高其设施的性能。 方法.对多达60次与初级保健、设施和 高、中、低性能设施的VISN领导。我们会分析访谈中的证据 跨设施的差异，在性能数据的有用性和战略的看法， 传播评价业绩的业绩数据，特别注意及时性， 个性化和反馈传递的惩罚性。我们将通过网络进行定性分析- 对18家机构的初级保健人员进行了基于调查，以检查EPRP数据实用性的看法 作为反馈来源，以及EPRP和其他数据来源（如果有的话） 以及时、个性化和非惩罚性的方式提供。

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.