Designing clinical practice feedback reports: three steps illustrated in Veterans Health Affairs long-term care facilities and programs

Abstract Background User-centered design (UCD) methods are well-established techniques for creating useful artifacts, but few studies illustrate their application to clinical feedback reports. When used as an implementation strategy, the content of feedback reports depends on a foundational audit process involving performance measures and data, but these important relationships have not been adequately described. Better guidance on UCD methods for designing feedback reports is needed. Our objective is to describe the feedback report design method for refining the content of prototype reports. Methods We propose a three-step feedback report design method (refinement of measures, data, and display). The three steps follow dependencies such that refinement of measures can require changes to data, which in turn may require changes to the display. We believe this method can be used effectively with a broad range of UCD techniques. Results We illustrate the three-step method as used in implementation of goals of care conversations in long-term care settings in the U.S. Veterans Health Administration. Using iterative usability testing, feedback report content evolved over cycles of the three steps. Following the steps in the proposed method through 12 iterations with 13 participants, we improved the usability of the feedback reports. Conclusions UCD methods can improve feedback report content through an iterative process. When designing feedback reports, refining measures, data, and display may enable report designers to improve the user centeredness of feedback reports.http://deepblue.lib.umich.edu/bitstream/2027.42/173835/1/13012_2019_Article_950.pd

Evaluating implementation strategies to support documentation of veterans’ care preferences

ObjectiveTo evaluate the effectiveness of feedback reports and feedback reports + external facilitation on completion of life-sustaining treatment (LST) note the template and durable medical orders. This quality improvement program supported the national roll-out of the Veterans Health Administration (VA) LST Decisions Initiative (LSTDI), which aims to ensure that seriously-ill veterans have care goals and LST decisions elicited and documented.Data SourcesPrimary data from national databases for VA nursing homes (called Community Living Centers [CLCs]) from 2018 to 2020.Study DesignIn one project, we distributed monthly feedback reports summarizing LST template completion rates to 12 sites as the sole implementation strategy. In the second involving five sites, we distributed similar feedback reports and provided robust external facilitation, which included coaching, education, and learning collaboratives. For each project, principal component analyses matched intervention to comparison sites, and interrupted time series/segmented regression analyses evaluated the differences in LSTDI template completion rates between intervention and comparison sites.Data Collection MethodsData were extracted from national databases in addition to interviews and surveys in a mixed-methods process evaluation.Principal FindingsLSTDI template completion rose from 0% to about 80% throughout the study period in both projects’ intervention and comparison CLCs. There were small but statistically significant differences for feedback reports alone (comparison sites performed better, coefficient estimate 3.48, standard error 0.99 for the difference between groups in change in trend) and feedback reports + external facilitation (intervention sites performed better, coefficient estimate −2.38, standard error 0.72).ConclusionsFeedback reports + external facilitation was associated with a small but statistically significant improvement in outcomes compared with comparison sites. The large increases in completion rates are likely due to the well-planned national roll-out of the LSTDI. This finding suggests that when dissemination and support for widespread implementation are present and system-mandated, significant enhancements in the adoption of evidence-based practices may require more intensive support.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/173095/1/hesr13958_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/173095/2/hesr13958.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/173095/3/hesr13958-sup-0001-Supinfo1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/173095/4/hesr13958-sup-0002-Supinfo2.pd