Performance Feedback in Health Care

Study Overview
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Brief Summary
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The Southeast Permanente Medical Group (TSPMG) at Kaiser Permanente Georgia provides performance feedback to its providers. The performance feedback designs can vary and change over time in terms of targets, summary statistics, included measures, and frequency of delivery. The TSPMG health services research group seek to compare different performance feedback designs to identify which are most effective at contributing to performance improvement. The research team will randomly assign providers into different performance feedback conditions, as specified in the protocol. Providers will receive performance feedback through the standard mechanism in which it is conveyed by their supervisor. The objective is to investigate how to design performance feedback for providers to best motivate and support them in improving performance along with existing strategic priorities for care delivery. The reserach team will test alternative designs of performance feedback that vary on the following dimension: 1) targets for comparison of one's own performance

Detailed Description
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The Southeast Permanente Medical Group (TSPMG) provides performance feedback to its providers. The performance feedback designs can vary and change over time in terms of targets, summary statistics, included measures, and frequency of delivery. The TSPMG health services research team will seek to compare different performance feedback designs to identify which are most effective at contributing to performance improvement. . The research team will randomly assign providers into different performance feedback conditions, as specified in the protocol. Providers will receive performance feedback through the standard mechanism in which it is conveyed by their supervisor. The objective is to investigate how to design performance feedback for providers to best motivate and support them in improving performance along with existing strategic priorities for care delivery. The research team will test alternative designs of performance feedback that vary on the following dimension: 1) targets for comparison of one's own performance The research team will provide feedback on performance by measures that the organization already tracks internally and uses for performance improvement. These include a provider's utilization of opportunities to provide flu vaccinations. The study will randomly assign different designs of feedback to providers. In order to understand which designs of feedback have the best effects on performance, the research team will test the following hypotheses: Displaying the next-highest quartile will motivate improvement more than display of all quartiles. Theory: The next-highest quartile will serve as an injunctive norm, or suggested target, to repeatedly lift an individual's performance to the suggested level. The positive effect of displaying the next-highest quartile, relative to displaying all quartiles, will be most pronounced for initially low performers. Theory: The next highest quartile averts upward social comparison to a much higher level of peer performance, which can be discouraging and so negatively affect performance The positive effect of displaying the next-highest quartile, relative to displaying all quartiles, will diminish over time. Theory: Individuals may become worn out as they see a target ratchet higher when their performance improves. Displaying team relative performance along with individual relative performance will be more effective than displaying either type of information alone.

Official Title
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Performance Feedback in Health Care

Conditions
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Influenza

Intervention / Treatment
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* Behavioral: The Impact of Performance Feedback and Variable Goal Setting on Flu Vaccination Success Rates of Providers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: A healthcare provider practicing at The Southeast Permanente Medical Group in a specialty for which the performance measure being studied is relevant. Health care providers include: Physicians, Nurse Practitioner, Certified Nurse Midwife, Psych Nurse Specialist, Optometrist, Podiatrist, and Physician Assistant Exclusion Criteria: Non-Physicians: Registered Nurses excluding nurse practitioners
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Providers are randomized to receive one of three designs of performance feedback, related to their rate of successful flu vaccinations among total flu opportunities
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Organizational Target<br>Providers are shown the flu success performance rate of their team (a pod, or group of providers who practice together), in comparison to their own, and with the organizational target. These updates and targets are sent bi-weekly. | Behavioral: The Impact of Performance Feedback and Variable Goal Setting on Flu Vaccination Success Rates of Providers<br>* A given provider will be involved in the study for a maximum of 6 months. This will involve, at the most frequent, the delivery of weekly performance feedback. The performance feedback will be delivered using standard approaches already in place in the organization and there will not be a period of seeking out participants for enrollment. Providers will receive performance feedback bi-weekly for the duration of the study period.<br>|
| Experimental: Achievable Target<br>Providers are shown the flu success performance rate of their team (a pod, or group of providers who practice together), in comparison to their own. They will receive a static and achievable target based on their previous year's flu vaccination success rate. | Behavioral: The Impact of Performance Feedback and Variable Goal Setting on Flu Vaccination Success Rates of Providers<br>* A given provider will be involved in the study for a maximum of 6 months. This will involve, at the most frequent, the delivery of weekly performance feedback. The performance feedback will be delivered using standard approaches already in place in the organization and there will not be a period of seeking out participants for enrollment. Providers will receive performance feedback bi-weekly for the duration of the study period.<br>|
| Experimental: Variable<br>Providers are shown the flu success performance rate of their team (a pod, or group of providers who practice together), in comparison to their own. They will receive a variable target that will fluctuate bi-weekly, based on their previous bi-weekly flu vaccination success rate. | Behavioral: The Impact of Performance Feedback and Variable Goal Setting on Flu Vaccination Success Rates of Providers<br>* A given provider will be involved in the study for a maximum of 6 months. This will involve, at the most frequent, the delivery of weekly performance feedback. The performance feedback will be delivered using standard approaches already in place in the organization and there will not be a period of seeking out participants for enrollment. Providers will receive performance feedback bi-weekly for the duration of the study period.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Flu Vaccination Administered During Encounter | Whether or not the providers succeeded in administering flu vaccination during flu vaccination opportunity | 10 Weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Flu Vaccination Provision, Performance Feedback, Variable Goal Setting, Flu Vaccination Success Rate, Health Care Providers