How can we optimise the impact and effectiveness of national clinical audit data?

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

I.13

Presenter:

Thomas Willis

Twitter:

@AU_PrimaryCare

Co-authors:

Ana Weller, Steph Wilson, Mohamed Althaf, Alex Wright-Hughes, Rebecca Walwyn, Amanda Farrin, Robbie Foy

Author institutions:

Leeds Institute of Health Sciences, University of Leeds; Centre for HCI Design, City, University of London; Leeds Institute of Clinical Trials Research, University of Leeds

Problem

Audit and feedback (A&F) aims to improve patient care by reviewing health care performance against explicit standards. The National Diabetes Audit (NDA) includes around 8,000 general practices in England. A&F has been shown to have significant effects on patient care, with the potential for substantial population impacts. However, the effects are variable and research is needed to optimise the content, format and delivery of feedback.

Approach

We conducted an innovative, fractional factorial web-based experiment. We worked with five national clinical audits, including the NDA, to evaluate six ways of enhancing the impact of feedback: recommending specific actions; using comparators that reinforce desired behaviour change; minimizing extraneous cognitive load for feedback recipients; providing feedback in more than one way; providing short, actionable messages following by option detail; and including a patient statement. The experimental design meant that participants were randomised to one of 32 experimental combinations of these six components. The design permitted consideration of the effects of individual experimental components, as well as two- and three-way interactions. Collaborating audits shared an invitation to participate with their existing distribution networks. Participants completed the study via a specially designed online portal. After indicating the audit with which they were familiar, participants were presented with an excerpt of an audit report. This was followed by a short questionnaire. The primary outcome was intended enactment of a specific clinical recommendation. Other outcomes assessed were comprehension, user experience, preferences and engagement with the content.

Findings

Analysis is underway, with the primary analysis drawing upon data from 638 participants, including 204 for the NDA. We will consider the findings from the NDA respondents in comparison with those of the entire sample.

Consequences

The findings will have implications for the design of national clinical audits, with the potential to enhance the effectiveness of the NDA and improve the delivery of care for patients with diabetes in UK primary care. We will also highlight more general lessons for the use of clinical audit and feedback in primary care.

Submitted by:

Thomas Willis

Funding acknowledgement:

The research was funded by the National Institute for Health Research (NIHR) under its Health Services & Delivery Research Programme (Reference Number 16/04/13). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.