|J. Stuart Wolf, Jr., MD||Dr. Wolf,|
The work of Kaplan and associates from UCLA, highlighted in the June 2017 issue of Urology Times, provides a sobering reminder of the difficulties in changing physician practice. Briefly, the authors found that data feedback, in this case about adherence to BPH management protocols, was insufficient-as the sole strategy-to improve care more than modestly.
Data feedback has assumed a prominent role in quality improvement efforts in health care, with varying success. Data dashboards are frequently used by clinical and operational leaders to inform decisions about quality improvement targets. This feedback is an integral part of the “Plan-Do-Check-Adjust” cycle of quality improvement.
Data feedback directly to physicians and other providers, however, often is less effective. We have all seen monitors or posters displaying time since the last accident at work, monthly adherence to hand-washing, rate of re-admission within 30 days for this or that diagnosis, or similar metrics. There is no doubt that in some cases-where the barriers to quality improvement are minimal and the physician motivation to change practice exceeds the reasons not to do so-these simple data feedbacks can induce impressive improvements. In other settings, including that of Kaplan and associates, data feedback alone is not adequate.
A more effective method to use data feedback in quality improvement is to use it as only the first step in a more comprehensive program. What is most impactful is collaborative provider engagement and intervention that is based on the data. After identifying gaps in physician performance (which is where data feedback to individual physicians stops), a highly functioning quality collaborative then goes on to devise and implement strategies to improve performance by using factors associated with high performance to create care pathways or other clinical interventions. Interventions are then implemented with particular attention to helping low performers overcome their personal and systemic barriers. Such a system is used in successful quality collaboratives such as the Michigan Urologic Surgery Improvement Collaborative (MUSIC), and is being started in the AUA Quality (AQUA) Registry (see “First national urology-wide registry gathers steam").
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