Impact of public release of performance data on the behaviour of healthcare consumers and providers.

BACKGROUND: It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers. OBJECTIVES: To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies. SELECTION CRITERIA: We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis. MAIN RESULTS: We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects. AUTHORS\u27 CONCLUSIONS: The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes

Chocolate bar as an incentive did not increase response rate among physiotherapists: a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to assess the effect of a small incentive, a bar of dark chocolate, on response rate in a study of physiotherapy performance in patients with knee osteoarthritis.</p> <p>Findings</p> <p>Norwegian physiotherapists from private practice were randomised in blocks to an intervention group (n = 1027) receiving a bar of dark chocolate together with a data-collection form, and a control group (n = 1027) that received the data-collection form only. The physiotherapists were asked to prospectively complete the data-collection form by reporting treatments provided to one patient with knee osteoarthritis through 12 treatment sessions. The outcome measure was response rate of completed forms.</p> <p>Out of the 510 physiotherapists that responded, 280 had completed the data-collection form by the end of the study period. There was no difference between the chocolate and no-chocolate group in response rate of those who sent in completed forms. In the chocolate group, 142 (13.8%) returned completed forms compared to 138 (13.4%) in the control group, ARR = 0.4 (95% CI: -3.44 to 2.6).</p> <p>Conclusion</p> <p>A bar of dark chocolate did not increase response rate in a prospective study of physiotherapy performance. Stronger incentives than chocolate seem to be necessary to increase the response rate among professionals who are asked to report about their practice.</p> <p>Trial Registration</p> <p>Current Controlled Trials register: ISRCTN02397855</p

The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support

Background: Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. Methods: We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist. Results: We screened 5347 papers and selected 71 papers with relevant information on success factors for guideline-based CDS. From the selected papers, we developed a 16-factor checklist that is divided in four domains, i.e. the CDS context, content, system and implementation domains. The panel of experts evaluated the checklist positively as an instrument that could support people implementing guideline-based CDS across a wide range of settings globally. Patients and healthcare consumers identified guideline-based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy. Conclusions: The GUIDES checklist can support professionals in considering the factors that affect the success of CDS interventions. It may facilitate a deeper and more accurate understanding of the factors shaping CDS effectiveness. Relying on a structured approach may prevent that important factors are missed

Feedback : en studie kring feedback och dess inverkan på motivationen i sångundervisning

Syftet med detta arbete är att utveckla förståelsen för feedback och dess inverkan på motivationen i sångundervisningssituationer, så att metoder kan förbättras och kunskapen blir bredare för att ge god feedback. Forskningsfrågorna i arbetet är: Vad är feedback? Hur kan feedback upplevas av sångelever på musikinstitutsnivå? Hur kan jag som sånglärare ge den bästa möjliga feedbacken till mina elever? För att besvara mina forskningsfrågor använder jag mig av hermeneutisk forskningsansats, intervjuer av fyra sångelever på musikinstitutsnivå och litteraturstudier. Det kan konstateras att intervjusvaren tyder på att beröm, uppmuntran och positiva ord är en stark drivkraft till motivation. Även tydlig feedback som tyder på vad som behövs för att förbättras som sångare, är en nyckel till motivation hos respondenterna. Intervjusvaren visar att ingen av respondenterna vill vara utan feedback eftersom det är svårt att veta vad som måste förbättras och vad som redan görs bra utan feedback i sångundervisningen. De föredrar beröm, men vill även veta vad de behöver jobba på. Det som känns extra bra visar i denna forskning vara mycket prestationsrelaterad till lärarens feedback. Stor del av teorin blir bekräftad genom denna begränsade empiriska forskning.The aim of this thesis is to develop understanding of feedback and its impact on motivation in vocational education situations, so that methods can be improved and knowledge grows to provide good feedback. The research questions of this thesis are: What is feedback? How can feedback be experienced by vocal students at a institute of music? How can I, as a singing teacher, provide the best possible feedback to my students? To answer my research questions, I use hermeneutic research, interviews of four vocal students at a music institute and literature studies. It can be seen that the answers from the interview indicate that praising, encouragement and positive words are strong driving force for motivation. Even clear feedback suggesting what is needed to improve as a singer is a key to motivation among respondents. The answers from the interview show that none of the respondents want to be without feedback in their singing lessons because it is difficult to know what needs to be improved and what is already done well without feedback in the lessons. They prefer praise, but also want to know what needs a job base. Feedback that feels extraordinary shows in this research a very preform related effort to what the teacher’s statements are. A large part of the theory is confirmed by this limited empirical research

Ungdomsskolelæreres erfaring med og kunnskap om stamming : En spørreundersøkelse

Sammendrag Tittel Ungdomsskolelæreres erfaring med og kunnskap om stamming. En spørreundersøkelse. Bakgrunn og formål Stamming kan oppleves som et alvorlig problem i ungdomsalderen og skolesituasjonen kan by på ekstra utfordringer for ungdomsskoleelever som stammer. Lærerens innsikt i taleflytvansken og forståelse for elevens situasjon kan ha betydning for hvordan undervisningen tilrettelegges og være avgjørende for elevens opplevelse, deltakelse og utbytte av skolegangen. Jeg har møtt ungdommer som har fortalt om hvordan de opplevde å være elev som stammer og hørt om deres ulike erfaringer med lærere. Det gjorde at jeg fikk lyst til å undersøke hvilken innsikt og erfaring lærerne selv mener de har om stamming. Problemstilling Med utgangspunkt i bakgrunn og formål har oppgaven denne problemstillingen: På hvilken måte har ungdomsskolelærere erfaring med og kunnskap om stamming? Følgende fire forskningsspørsmål skal hjelpe til med å besvare problemstillingen: 1. Hvordan har ungdomsskolelærere erfaring med stamming? 2. Hvordan vurderer ungdomsskolelærere egen kunnskap om stamming? 3. Hvordan vurderer ungdomsskolelærere egen kunnskap om tilrettelegging av undervisning for elever som stammer? 4. I hvilken grad har ungdomsskolelærere behov for mer kunnskap om stamming og hvordan ønsker de i tilfelle å tilegne seg denne kunnskapen? Metode For å få svar på problemstillingen har jeg valgt å bruke en kvantitativ metode i form av en survey med spørreskjema for selvutfylling som teknikk for innsamling av data. Survey betyr bl.a. overblikk og kartlegging, og egner seg godt i undersøkelser med mange respondenter. Undersøkelsen ble foretatt på ulike ungdomsskoler i én kommune, og det ble dermed mulig å personlig dele ut spørreskjemaene. Undersøkelsen ble besvart av til sammen 88 respondenter og det tilsvarer en svarprosent på 77 %. Dataanalyse Dataprogrammet SPSS (Statistial Package for the Social Sciences) er brukt til bearbeiding av data og analyse av funn. Dataene er fremstilt i form av tekst, tabeller og figurer. Korrelasjonsmålet Pearsons r er brukt for å måle samvariasjon mellom enkelte av intervallvariablene, og t-test for uavhengige utvalg er brukt for å sammenligne ulike gruppers gjennomsnitt. Konklusjon Litt under halvparten av lærerne har opplevd å ha elever som stammer i klassen, og for litt over 70 % av dem dreier det seg da bare om én eller to elever. Kun åtte av disse lærerne har fått noen form for råd eller veiledning knyttet temaet. Det varierer hvem de har fått veiledning av. De fleste oppgir at de ikke lærte noe om stamming i grunnutdanningen. Det har heller ikke vært tatt opp som tema på kurs eller møter på arbeidsplassen. Enkelte lærere vurderer at de har middels eller svært god kunnskap om stamming og hvordan undervisning kan tilrettelegges, men gjennomsnittslæreren gjør ikke det. Det ser også ut til å være stor usikkerhet i forhold til hvor de kan søke råd og veiledning. Ut i fra dette er konklusjonen at ungdomsskolelærere generelt har liten erfaring med og kunnskap om stamming. De opplever derfor at de har behov for å lære mer, og et flertall ønsker at det skal skje gjennom veiledning av logoped

Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study)

Objective: To explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision

The Effect of Alternative Graphical Displays Used to Present the Benefits of Antibiotics for Sore Throat on Decisions about Whether to Seek Treatment: A Randomized Trial

In a randomized trial, Cheryl Carling and colleagues evaluate how people respond to different statistical presentations regarding the consequences of taking antibiotic treatment for sore throat

Tailored implementation for chronic diseases (TICD): A project protocol

Contains fulltext : 98393.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: The assumption underlying tailoring is that implementation interventions are most helpful if these effectively address the most important determinants of practice for improvement in the targeted setting. The aim of the Tailored Implementation For Chronic Diseases (TICD) project is to develop valid and efficient methods of tailoring implementation interventions to determinants of practice for knowledge implementation in chronic illness care. METHODS: The TICD project has organized the planned empirical research in three work packages that follow the three main steps of tailoring: identification of determinants of healthcare practice, matching implementation interventions to identified determinants of practice, and applying and assessing the tailored implementation interventions. These three key steps of tailored implementation will be applied to targeted chronic conditions in five different healthcare systems: cardiovascular disease in the Netherlands, obesity in England, depression in Norway, chronic obstructive pulmonary disease in Poland, and multimorbidity in Germany. The design and interpretation of empirical research will be informed by systematic reviews of previous research on tailoring implementation interventions. DISCUSSION: The TICD project will provide much needed evidence on the advantages and disadvantages of different methods of identifying important determinants of practice and selecting implementation strategies that take account of those. It will also provide five rigorous evaluations of tailored implementation interventions for five different chronic conditions