Quality improvement studies don't learn from their mistakes

Quality improvement programs for physicians can work, but most do not because those who operate such efforts fail to learn from past findings, according to a study in the Journal of General Internal Medicine. Researchers performed meta-regressions for trials involving audit and feedback published as of 2002, 2006, and 2010. These meta-regressions examined the impact different components of quality improvement initiatives might have on the behavior of health professionals and quality of care.

When included as part of quality improvement efforts, “Feedback appears most effective when: delivered by a supervisor or respected colleague; presented frequently; featuring both specific goals and action-plans; aiming to decrease the targeted behavior; baseline performance is lower; and recipients are nonphysicians,” says the study.

Though these approaches work, relatively few trials feature these components, which suggests a lack of systematic effort at optimizing the impact of quality improvement initiatives, say the researchers. The lesson might be that it doesn’t matter how often you study something if past lessons are not remembered.

Feedback in quality improvement studied

Factors explaining variability in effectiveness of feedback, as measured by absolute difference in compliance with intended professional behaviors

Source: Ivers NM, Grimshaw JM, Jamtvedt G, et al. Growing literature, stagnant science? Systematic review, meta-regression and cumulative analysis of audit and feedback interventions in health care. Journal of General Internal Medicine, June 26, 2014 [ePub ahead of print].

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