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The feasibility of automating audit and feedback for ART guideline adherence in Malawi.

Landis Lewis Z, Mello-Thoms C, Gadabu OJ, Gillespie EM, Douglas GP, Crowley RS - J Am Med Inform Assoc (2011)

Bottom Line: Feedback reports may support workplace learning by increasing HCWs' opportunities to reflect on their performance.A moderate number of recommendations from Malawi's ART guidelines can be used to generate automated guideline adherence feedback using existing EMR data.Further study is needed to determine the receptivity of HCWs to peer comparison feedback and barriers to implementation of automated audit and feedback in low-resource settings.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Informatics, Center for Health Informatics for Underserved, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA. zjl1@pitt.edu

ABSTRACT

Objective: To determine the feasibility of using electronic medical record (EMR) data to provide audit and feedback of antiretroviral therapy (ART) clinical guideline adherence to healthcare workers (HCWs) in Malawi.

Materials and methods: We evaluated recommendations from Malawi's ART guidelines using GuideLine Implementability Appraisal criteria. Recommendations that passed selected criteria were converted into ratio-based performance measures. We queried representative EMR data to determine the feasibility of generating feedback for each performance measure, summed clinical encounters representing each performance measure's denominator, and then measured the distribution of encounter frequency for individual HCWs across nurse and clinical officer groups.

Results: We analyzed 423,831 encounters in the EMR data and generated automated feedback for 21 recommendations (12%) from Malawi's ART guidelines. We identified 11 nurse recommendations and eight clinical officer recommendations. Individual nurses and clinical officers had an average of 45 and 59 encounters per month, per recommendation, respectively. Another 37 recommendations (21%) would support audit and feedback if additional routine EMR data are captured and temporal constraints are modeled.

Discussion: It appears feasible to implement automated guideline adherence feedback that could potentially improve HCW performance and supervision. Feedback reports may support workplace learning by increasing HCWs' opportunities to reflect on their performance.

Conclusion: A moderate number of recommendations from Malawi's ART guidelines can be used to generate automated guideline adherence feedback using existing EMR data. Further study is needed to determine the receptivity of HCWs to peer comparison feedback and barriers to implementation of automated audit and feedback in low-resource settings.

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Methods for identification of candidate, decidable, executable, measurable, computable, and auditable recommendations.
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fig1: Methods for identification of candidate, decidable, executable, measurable, computable, and auditable recommendations.

Mentions: We created a CPG and EMR evaluation process to determine the feasibility of generating HCW performance feedback. For this evaluation we used only CPG statements that directly addressed clinical management of adult ART patients from Treatment of AIDS. We began by identifying candidate recommendations from the CPG. We then identified each candidate recommendation's components and evaluated them using criteria for decidability, executability, measurability, computability, and auditability. Each stage of the process identified a subset of the preceding stage to arrive at a final set of recommendations that were suitable for generating feedback using EMR data from Malawi (figure 1).


The feasibility of automating audit and feedback for ART guideline adherence in Malawi.

Landis Lewis Z, Mello-Thoms C, Gadabu OJ, Gillespie EM, Douglas GP, Crowley RS - J Am Med Inform Assoc (2011)

Methods for identification of candidate, decidable, executable, measurable, computable, and auditable recommendations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3197989&req=5

fig1: Methods for identification of candidate, decidable, executable, measurable, computable, and auditable recommendations.
Mentions: We created a CPG and EMR evaluation process to determine the feasibility of generating HCW performance feedback. For this evaluation we used only CPG statements that directly addressed clinical management of adult ART patients from Treatment of AIDS. We began by identifying candidate recommendations from the CPG. We then identified each candidate recommendation's components and evaluated them using criteria for decidability, executability, measurability, computability, and auditability. Each stage of the process identified a subset of the preceding stage to arrive at a final set of recommendations that were suitable for generating feedback using EMR data from Malawi (figure 1).

Bottom Line: Feedback reports may support workplace learning by increasing HCWs' opportunities to reflect on their performance.A moderate number of recommendations from Malawi's ART guidelines can be used to generate automated guideline adherence feedback using existing EMR data.Further study is needed to determine the receptivity of HCWs to peer comparison feedback and barriers to implementation of automated audit and feedback in low-resource settings.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Informatics, Center for Health Informatics for Underserved, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA. zjl1@pitt.edu

ABSTRACT

Objective: To determine the feasibility of using electronic medical record (EMR) data to provide audit and feedback of antiretroviral therapy (ART) clinical guideline adherence to healthcare workers (HCWs) in Malawi.

Materials and methods: We evaluated recommendations from Malawi's ART guidelines using GuideLine Implementability Appraisal criteria. Recommendations that passed selected criteria were converted into ratio-based performance measures. We queried representative EMR data to determine the feasibility of generating feedback for each performance measure, summed clinical encounters representing each performance measure's denominator, and then measured the distribution of encounter frequency for individual HCWs across nurse and clinical officer groups.

Results: We analyzed 423,831 encounters in the EMR data and generated automated feedback for 21 recommendations (12%) from Malawi's ART guidelines. We identified 11 nurse recommendations and eight clinical officer recommendations. Individual nurses and clinical officers had an average of 45 and 59 encounters per month, per recommendation, respectively. Another 37 recommendations (21%) would support audit and feedback if additional routine EMR data are captured and temporal constraints are modeled.

Discussion: It appears feasible to implement automated guideline adherence feedback that could potentially improve HCW performance and supervision. Feedback reports may support workplace learning by increasing HCWs' opportunities to reflect on their performance.

Conclusion: A moderate number of recommendations from Malawi's ART guidelines can be used to generate automated guideline adherence feedback using existing EMR data. Further study is needed to determine the receptivity of HCWs to peer comparison feedback and barriers to implementation of automated audit and feedback in low-resource settings.

Show MeSH