A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies
Abstract Background Audit and feedback (A&F) is a widely used implementation strategy. Understanding mechanisms of action of A&F increases the likelihood that the strategy will lead to implementation of an evidence-based practice. We therefore sought to understand one hospital’s experience s...
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doaj-12be5a0ff2ff4d0085de804de4b7e2c72021-04-04T11:08:17ZengBMCImplementation Science1748-59082021-04-0116111310.1186/s13012-021-01102-6A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategiesMellanie V. Springer0Anne E. Sales1Nishat Islam2A. Camille McBride3Zach Landis-Lewis4Michael Tupper5Casey L. Corches6Maria Cielito Robles7Lesli E. Skolarus8Stroke Program, University of Michigan Medical SchoolDepartment of Veteran Affairs Center for Clinical Management ResearchSchool of Public Health, University of MichiganSchool of Public Health, University of MichiganDepartment of Learning Health Sciences, University of MichiganUniversity of Michigan Medical SchoolStroke Program, University of Michigan Medical SchoolStroke Program, University of Michigan Medical SchoolStroke Program, University of Michigan Medical SchoolAbstract Background Audit and feedback (A&F) is a widely used implementation strategy. Understanding mechanisms of action of A&F increases the likelihood that the strategy will lead to implementation of an evidence-based practice. We therefore sought to understand one hospital’s experience selecting and implementing an A&F intervention, to determine the implementation strategies that were used by staff and to specify the mechanism of action of those implementation strategies using causal pathway models, with the ultimate goal of improving acute stroke treatment practices. Methods We selected an A&F strategy in a hospital, initially based on implementation determinants and staff consideration of their performance on acute stroke treatment measures. After 7 months of A&F, we conducted semi-structured interviews of hospital providers and administrative staff to understand how it contributed to implementing guideline-concordant acute stroke treatment (medication named tissue plasminogen activator). We coded the interviews to identify the implementation strategies that staff used following A&F and to assess their mechanisms of action. Results We identified five implementation strategies that staff used following the feedback intervention. These included (1) creating folders containing the acute stroke treatment protocol for the emergency department, (2) educating providers about the protocol for acute stroke, (3) obtaining computed tomography imaging of stroke patients immediately upon emergency department arrival, (4) increasing access to acute stroke medical treatment in the emergency department, and (5) providing additional staff support for implementation of the protocol in the emergency department. We identified enablement, training, and environmental restructuring as mechanisms of action through which the implementation strategies acted to improve guideline-concordant and timely acute stroke treatment. Conclusions A&F of a hospital’s acute stroke treatment practices generated additional implementation strategies that acted through various mechanisms of action. Future studies should focus on how initial implementation strategies can be amplified through internal mechanisms.https://doi.org/10.1186/s13012-021-01102-6Audit and feedbackImplementation strategiesMechanism of actionCausal pathway modelsStroke |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mellanie V. Springer Anne E. Sales Nishat Islam A. Camille McBride Zach Landis-Lewis Michael Tupper Casey L. Corches Maria Cielito Robles Lesli E. Skolarus |
spellingShingle |
Mellanie V. Springer Anne E. Sales Nishat Islam A. Camille McBride Zach Landis-Lewis Michael Tupper Casey L. Corches Maria Cielito Robles Lesli E. Skolarus A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies Implementation Science Audit and feedback Implementation strategies Mechanism of action Causal pathway models Stroke |
author_facet |
Mellanie V. Springer Anne E. Sales Nishat Islam A. Camille McBride Zach Landis-Lewis Michael Tupper Casey L. Corches Maria Cielito Robles Lesli E. Skolarus |
author_sort |
Mellanie V. Springer |
title |
A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies |
title_short |
A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies |
title_full |
A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies |
title_fullStr |
A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies |
title_full_unstemmed |
A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies |
title_sort |
step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies |
publisher |
BMC |
series |
Implementation Science |
issn |
1748-5908 |
publishDate |
2021-04-01 |
description |
Abstract Background Audit and feedback (A&F) is a widely used implementation strategy. Understanding mechanisms of action of A&F increases the likelihood that the strategy will lead to implementation of an evidence-based practice. We therefore sought to understand one hospital’s experience selecting and implementing an A&F intervention, to determine the implementation strategies that were used by staff and to specify the mechanism of action of those implementation strategies using causal pathway models, with the ultimate goal of improving acute stroke treatment practices. Methods We selected an A&F strategy in a hospital, initially based on implementation determinants and staff consideration of their performance on acute stroke treatment measures. After 7 months of A&F, we conducted semi-structured interviews of hospital providers and administrative staff to understand how it contributed to implementing guideline-concordant acute stroke treatment (medication named tissue plasminogen activator). We coded the interviews to identify the implementation strategies that staff used following A&F and to assess their mechanisms of action. Results We identified five implementation strategies that staff used following the feedback intervention. These included (1) creating folders containing the acute stroke treatment protocol for the emergency department, (2) educating providers about the protocol for acute stroke, (3) obtaining computed tomography imaging of stroke patients immediately upon emergency department arrival, (4) increasing access to acute stroke medical treatment in the emergency department, and (5) providing additional staff support for implementation of the protocol in the emergency department. We identified enablement, training, and environmental restructuring as mechanisms of action through which the implementation strategies acted to improve guideline-concordant and timely acute stroke treatment. Conclusions A&F of a hospital’s acute stroke treatment practices generated additional implementation strategies that acted through various mechanisms of action. Future studies should focus on how initial implementation strategies can be amplified through internal mechanisms. |
topic |
Audit and feedback Implementation strategies Mechanism of action Causal pathway models Stroke |
url |
https://doi.org/10.1186/s13012-021-01102-6 |
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