Background: With the advent of the electronic health records an increasing amount of data is available for feedback to physicians. However, the impact of regular team-based feedback is unknown particularly physician perceptions of the relevance and utility for their clinical practice.

Methods:

As part of a previous project resident QI champions with analytic help from the Division of Hospital Medicine provided team-based feedback on a quality dashboard to attendings and residents at our academic medical center. 8 medicine teams (A-H) received a twice monthly email for 18 months (Figure 1). We developed a survey to assess: 1) awareness of feedback email 2) ability of email to stimulate discussion 3) perceptions of the metrics chosen 4) perceived impact on quality of care. We surveyed 181 residents and 64 hospitalist attendings who received the team-based dashboard.

Results:

126/181 (70%) residents and 46/64 (72%) attendings responded to our survey. 111 (88%) residents and 41(89%) attendings acknowledged receiving feedback, however only 80 (63%) residents and 26 (57%) attendings reported discussing performance on quality metrics with their team during their time on service (Table 1).  The majority of providers agreed that data was easy to interpret and improvements were within their control. While most disagreed, a third of respondents felt receiving data added to their workload. Survey responses revealed that feedback should be timelier and linked to patient charts in order to change behavior. For example, one resident stated, “Ideally the data dashboard should be in real time and include both team and individual metrics. Should have ability to identify which patients missed the mark so you can reflect on how your care could have been optimized.” Despite 65 (52%) residents and 25 attendings (54%) agreeing that improvements translated into improved quality of care, only 31 (25%) and 7 (15%) attendings felt that the data was an accurate reflection the quality of care provided by their team. A resident commented “focusing on these metrics is fine, but not an accurate measurement of overall quality of care, so this much focus on these 6 things doesn’t seem fair or right.”

Conclusions:

Physicians noted the limitations of timeliness as well as a perception that feedback focusing on selected quality metrics only provide an incomplete assessment of actual care provided. Quality leaders need to acknowledge the limitations of quality metrics while communicating how selected metrics meaningfully translate into improvements in care in order to achieve maximal buy-in.