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Optimizing Audit and Feedback Interventions to Improve Quality in Primary Care.

机译：优化审计和反馈干预措施，以提高基层医疗质量。

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摘要

One of the most consistent findings in health services research relates to gaps between ideal and actual care. Audit and feedback is frequently implemented to help providers identify these gaps and to subsequently improve quality of care, with widely varying results. The overall aim of this thesis was to examine how to optimize audit and feedback interventions provided to family physicians to more reliably result in professional behaviour change that will benefit patients. A systematic review, meta-analysis, and meta-regression was conducted to determine the effect of audit and feedback interventions on quality of care and to identify effect modifiers. The review included 140 trials and found that audit and feedback works best when the source is a supervisor or colleague, it is provided more than once, it is delivered in both verbal and written formats, and when it includes both explicit targets and an action plan. Based on the latter finding and applying principles from relevant behaviour change theories, a worksheet was developed to guide feedback recipients in setting appropriate goals and action plans in response to identified gaps in care. This worksheet was tested in a pragmatic, cluster-randomized trial including 53 family physicians from 14 practices across Ontario. All participating family physicians received feedback every six months regarding the proportion of patients with diabetes and/or heart disease receiving guideline-recommended care. Family physicians in the intervention group also received the worksheet appended to the feedback reports. After two years, no significant effects differences were found between the groups, in part because of poor uptake of the worksheet. An embedded qualitative evaluation examined the barriers and facilitators to improving quality of care for chronic disease management perceived by family physicians who received the feedback reports. Findings highlighted the importance of matching the targeted behaviour change(s) with the priorities and capabilities of recipients and their organizations.
机译：卫生服务研究中最一致的发现之一与理想护理与实际护理之间的差距有关。经常执行审计和反馈，以帮助提供者发现这些差距并随后提高护理质量，并产生广泛的结果。本文的总体目标是研究如何优化提供给家庭医生的审核和反馈干预措施，以更可靠地导致职业行为改变，从而使患者受益。进行了系统的审查，荟萃分析和荟萃回归，以确定审计和反馈干预措施对护理质量的影响并确定影响因素。审查包括140项试验，发现审计和反馈在以下情况下效果最佳：来源是主管或同事，提供不止一次，以口头和书面形式提供，并且同时包含明确的目标和行动计划。基于后者的发现并根据相关行为改变理论应用原则，开发了一个工作表，以指导反馈接受者制定适当的目标和行动计划，以应对已确定的护理差距。该工作表在实用，整群随机试验中进行了测试，该试验包括来自安大略省14个诊所的53位家庭医生。所有参与的家庭医生每六个月都会收到有关接受指南推荐治疗的糖尿病和/或心脏病患者比例的反馈。干预组的家庭医生也收到了附在反馈报告中的工作表。两年后，两组之间均未发现明显的效果差异，部分原因是工作表摄取不足。一项嵌入式定性评估研究了收到反馈报告的家庭医生认为改善慢性病管理的护理质量的障碍和促进因素。调查结果强调了使目标行为改变与接收者及其组织的优先级和能力相匹配的重要性。

著录项

  • 作者

    Ivers, Noah Michael.;

  • 作者单位

    University of Toronto (Canada).;

  • 授予单位 University of Toronto (Canada).;
  • 学科 Health Sciences Health Care Management.;Health Sciences Epidemiology.;Health Sciences Public Health.
  • 学位 Ph.D.
  • 年度 2014
  • 页码 265 p.
  • 总页数 265
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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