Effectiveness and cost of different strategies for information feedback in general practice.
ABSTRACT The aim of this study was to determine the effectiveness and relative cost of three forms of information feedback to general practices--graphical, graphical plus a visit by a medical facilitator and tabular.
Routinely collected, centrally-held data were used where possible, analysed at practice level. Some non-routine practice data in the form of risk factor recording in medical notes, for example weight, smoking status, alcohol consumption and blood pressure, were also provided to those who requested it. The 52 participating practices were stratified and randomly allocated to one of the three feedback groups. The cost of providing each type of feedback was determined. The immediate response of practitioners to the form of feedback (acceptability), ease of understanding (intelligibility), and usefulness of regular feedback was recorded. Changes introduced as a result of feedback were assessed by questionnaire shortly after feedback, and 12 months later. Changes at the practice level in selected indicators were also assessed 12 and 24 months after initial feedback.
The resulting cost per effect was calculated to be 46.10 pounds for both graphical and tabular feedback, 132.50 pounds for graphical feedback plus facilitator visit and 773.00 pounds for the manual audit of risk factors recorded in the practice notes. The three forms of feedback did not differ in intelligibility or usefulness, but feedback plus a medical facilitator visit was significantly less acceptable. There was a high level of self-reported organizational change following feedback, with 69% of practices reporting changes as a direct result; this was not significantly different for the three types of feedback. There were no significant changes in the selected indicators at 12 or 24 months following feedback. The practice characteristic most closely related to better indicators of preventive practice was practice size, smaller practices performing significantly better. Separate clinics were not associated with better preventive practice.
It is concluded that feedback strategies using graphical and tabular comparative data are equally cost-effective in general practice with about two thirds of practices reporting organizational change as a consequence; feedback involving unsolicited medical facilitator visits is less cost-effective. The cost-effectiveness of manual risk factor audit is also called into question.
Full-textDOI: · Available from: John Wilmot, May 20, 2014
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ABSTRACT: This review was conducted to determine the effectiveness of different interventions to improve the delivery of preventive services in primary care. MEDLINE searches and manual searches of 21 scientific journals and the Cochrane Effective Professional and Organization of Care of trials were used to identify relevant studies. Randomized controlled trials and controlled before-and-after studies were included if they focused on interventions designed to improve preventive activities by primary care clinicians. Two researchers independently assessed the quality of the studies and extracted data for use in constructing descriptive overviews. The 58 studies included comprised 86 comparisons between intervention and control groups. Postintervention differences between intervention and control groups varied widely within and across categories of interventions. Most interventions were found to be effective in some studies, but not effective in other studies. Effective interventions to increase preventive activities in primary care are available. Detailed studies are needed to identify factors that influence the effectiveness of different interventions.American Journal of Public Health 06/1999; 89(5):737-46. DOI:10.2105/AJPH.89.5.737 · 4.23 Impact Factor
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ABSTRACT: To determine (1) how medical registries provide information feedback to health care professionals, (2) whether this feedback has any effect on the quality of care and (3) what the barriers and success factors are to the effectiveness of feedback. Original articles in English found in MEDLINE Pubmed covering the period January 1990 to August 2007. Titles and abstracts of 6223 original articles were independently screened by two reviewers to determine relevance for further review. We used a standardized data abstraction form to collect information on the feedback initiatives and their effectiveness. The effect of the feedback was only described for analytic papers, i.e. papers that attempted to objectively quantify the effect on the quality of care and to relate this effect to feedback as an intervention. For analysis of the effectiveness, we categorized the initiatives based on the number of elements added to the feedback. We included 53 papers, describing 50 feedback initiatives, of which 39 were part of a multifaceted approach. Our results confirm previous research findings that adding elements to a feedback strategy positively influences its effectiveness. We found 22 analytic studies, four of which found a positive effect on all outcome measures, eight found a mix of positive- and no effects and ten did not find any effects (neither positive nor negative). Of the 43 process of care measures evaluated in the analytic studies, 26 were positively affected by the feedback initiative. Of the 36 evaluated outcome of care measures, five were positively affected. The most frequently mentioned factors influencing the effectiveness of the feedback were: (trust in) quality of the data, motivation of the recipients, organizational factors and outcome expectancy of the feedback recipients. The literature on methods and effects of information feedback by medical registries is heterogeneous, making it difficult to draw definite conclusions on its effectiveness. However, the positive effects cannot be discarded. Although our review confirms findings from previous studies that process of care measures are more positively influenced by feedback than outcome of care measures, further research should attempt to identify outcome of care measures that are sensitive to behaviour change as a result of feedback strategies. Furthermore, future studies evaluating the effectiveness of feedback should include a more extensive description of their intervention in order to increase the reproducibility of feedback initiatives and the generalizability of the results.International Journal of Medical Informatics 02/2010; 79(5):305-23. DOI:10.1016/j.ijmedinf.2010.01.011 · 2.72 Impact Factor