Lipstick on a pig: Qualitative understanding of the efforts to redesign electronic audit and feedback reports for primary care. (Preprint)
Notice bibliographique
Résumé
BACKGROUND In Ontario, Canada, a government agency known as Ontario Health is responsible for making audit and feedback reports available to all family physicians. The confidential report provides summary data on three key areas of practice: safe prescribing, cancer screening, and diabetes management. OBJECTIVE This report was redesigned to improve its usability and the objective of this study was to explore how the redesign was perceived. METHODS We conducted qualitative semi-structured interviews with family physicians who had experience with both versions of the report, recruited through purposeful and snowball sampling. We analysed the transcripts following an emergent and iterative approach. RESULTS Saturation was reached after 17 family physicians participated. Two key themes emerged as factors that impacted the perceived usability of the report: (1) alignment between report and recipients’ expectations and (2) capacity to engage in quality improvement. Family physicians expected the report and its quality indicators to reflect best practice, to be valid and accurate. They also expected the report to offer feedback on clinical activities they perceived were within their control to change. Further, family physicians expected the goal of the report to be aligned with their perspective on feasible quality improvement activities. Most of these expectations were not met, limiting the perceived usability of the report. The capacity to engage with audit and feedback was hindered by several organizational and physician-level barriers including the lack of fit with existing workflow, competing priorities, time constraints, and insufficient skills for bridging the gaps between their data and the corresponding desired actions. CONCLUSIONS Overall, the redesigned feedback report was not perceived as highly usable, given the misalignement between report and family physicians’ expectations as well as limited capacity to engage with the report. Consequently, the potential impact on clinical practice may be limited. Co-interventions to address the barriers of using audit and feedback report, as well as creating space for bridging together audit and feedback designers and recipients are avenues to consider for improving usability and effectiveness such quality improvement initiatives.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,054 | 0,099 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,008 | 0,013 |
| Communication savante | 0,006 | 0,009 |
| Science ouverte | 0,002 | 0,008 |
| Intégrité de la recherche | 0,003 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».