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Amsterdam Public Healthresearch institute
Learning more from audit & feedback in multicenter studies
Martine de Bruijne, Cordula Wagner, Jeremy Grimshaw
Program
1. Feedback in the national patient safety study in Dutch hospitals (Cordula
Wagner)
2. Visualisation of quality information (Martine de Bruijne)
3. Principles of audit and feedback. Top down (Jeremy Grimshaw)
4. Apply theory to your own situation (small groups)
5. Plenary discussion group findings (Jeremy Grimshaw)
Feedback in multicenter studies| May 2019
Multicenter studies on patient safety
Feedback in multicenter studies| May 2019
Aim: to improve patient safety in Dutch hospitals
Method: measurement/audit & feedback
1. Record review study on adverse events in 21 hospitals
2. Medication review in 15 hospitals
3. Quality improvement: care for frail elderly in 10 hospitals
Measuring adverse events
- Adverse event?
- Harm to patient?
- Caused by careprofessional / organization?
- Preventable?
-
+
Triggers?
Results of adverse events studies of deseasedhospital patients
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
2004 2008 2011/2012 2015/2016
Pe
rce
nta
ge v
an t
ota
al a
anta
l ove
rle
de
ne
n
not preventable
preventable harm
preventable death
Preventable adverse events in 21 hospitals
0,0%
0,5%
1,0%
1,5%
2,0%
2,5%
3,0%
3,5%
4,0%
4,5%
5,0%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
ziekenhuizen
ve
rmijd
ba
re o
nb
ed
oe
lde
sc
ha
de
Participating
hospitals receive
their number for
comparison
Quality improvement cycle
Patient safety
improvement
program
Medication review in 15 hospitals: bundle compliance
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
hospital admission
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
hospital discharge
Comparison of hospitals who know their number. Exchange of knowledge for learning purposes.
Example: frail elderly 70+ in hospitals
Indicator: application bundle screening
(risk on delier, falls, malnutrition, fysical constraints)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2 3 4 5 6 7 8 9 10 11
Measurement
Every
hospital
receives
their
own
graph
based on
record
review
Questions
How to improve patient safety in Dutch hospitals by audit & feedback of outcomes?
Hospitals were very interested in their results. External pressure and ambition.
Improvement projects were coordinated at a national level.
Advice and support were available via continuous education and expert meetings
Principles of actionable visualisationof quality information
Feedback in multicenter studies| May 2019
https://www.sturenopkwaliteit.nl/uploads/
pdf/Handleiding_grafische_vormgeving_van_
dashboards_NFU_Sturen_op_Kwaliteit.pdf
Design steps
Amsterdam Public Health research institute | October 2018
Central purpose
User group
Functionality
Data colletion
Scratch design
Test
Optimise
Who do you want to inform? Who should act?
Amsterdam Public Health research institute | October 2018
Work floor
Inspectorate
Hospital board
Division
Department
Quality improvement
Feedback in multicenter studies| May 2019
Hard signals & soft signals
Feedback in multicenter studies| May 2019
Design rules in literature
‘Less is more’
Flexibility
Clear and surveyable
Comprehensive
Use of colours
!! What you like ≠ what you understand !! Damman & Malanda zorginzicht.nl
Few perceptualedge.com
Evergreen stephanieevergreen.com
Feedback in multicenter studies| May 2019
Design rules from focus groups
Feedback in multicenter studies| May 2019
Max 8 to10 indicators
Benchmark: internal targets
Increase/decrease at first sight
Flexible ordering of information
Show trends
Keep track of dashboard search
Meaningfull & actionable
Explanation
Increase/decrease
Colours and symbols
Report improvement initiative
Feedback in multicenter studies| May 2019
Graphs
Bars
Lines
Pie chart
Scatterplot
KPI meter
Population graphs
Symbols, pictograms
Feedback in multicenter studies| May 2019
Tables
Feedback in multicenter studies| May 2019
Alignment
Feedback in multicenter studies| May 2019
Visualisationis not alwayshelpfull
Feedback in multicenter studies| May 2019
Questions?
Feedback in multicenter studies| May 2019
