How can national clinical audit be optimised to improve the primary care of diabetes?

Conference:

SAPC ASM 2021 - virtual

Talk Code:

P1.16.5

Presenter:

Thomas Willis

Twitter:

@AU_PrimaryCare

Co-authors:

Su Wood, Jamie Brehaut, Heather Colquhoun, Benjamin Brown, Fabiana Lorencatto, Robbie Foy

Author institutions:

Leeds Institute of Health Sciences, University of Leeds (TW, SW, RF); Ottawa Hospital Research Institute (JB); Department of Occupational Science and Occupational Therapy, University of Toronto (HC); Centre for Health Informatics, University of Manchester (BB); Centre for Behaviour Change, University College London (FL)

Problem

Audit and feedback is a widely used healthcare quality improvement tool, whereby achievement against specified standards is monitored and shared with clinical teams. It is generally but inconsistently effective and research is needed to understand how to optimise its impact. We examined outputs from two United Kingdom national clinical audits: the National Diabetes core Audit (NDA), which monitors primary care diabetes management and has a significant reach to approximately 8000 general practices, and the Trauma Audit Research Network (TARN). Both audits have recently made changes to their delivery of feedback; comparisons of their methods can offer insights for improvement. We drew upon Clinical Performance Feedback Intervention Theory (CP-FIT), a comprehensive theory of feedback, to identify opportunities for strengthening the feedback cycle for diabetes.

Approach

We completed semi-structured interviews with 19 individuals with relevant experience and knowledge, including audit and feedback researchers, audit managers, healthcare staff, and patient and public representatives. Interviews were structured around the CP-FIT feedback cycle, with participants invited to discuss one or both audits. We utilised rapid analysis techniques to explore the extent to which both audits achieved (or not) each of the cycle processes. We produced summaries of each interview rather than full, formal coding; the summaries were then combined to produce a matrix of positive and negative comments for each audit together with illustrative quotes.

Findings

We produced detailed assessments of both audits. Interviewees identified features of both audits that were likely to influence successful progress through the feedback cycle. The NDA’s move to more frequent data release was considered consistent with best evidence and meet the needs of users. Potential barriers to progress were difficulties reaching target recipients, off-putting data presentation, and a failure to provide recommendations for action.

Consequences

Our findings suggest ways in which feedback to general practices could be further strengthened and hence improve the delivery of diabetes care. Audit and feedback is used locally and nationally as a primary care quality improvement tool and our study emphasises the importance of ensuring the fundamentals are achieved. Namely, ensuring the feedback actually reaches its intended target, and then making sure that it is user-friendly and easy to interpret. Failure to do this is likely to prevent clinical audit from achieving its aim of improving patient care.

Submitted by:

Thomas Willis

Funding acknowledgement:

This study was funded by the National Institute for Health Research (NIHR) [Health Services & Delivery Research programme (project reference 16/04/13)]. The view expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funding body had no role in the design of the study, the collection, analysis and interpretation of the data, nor the preparation of the manuscript.