Lavigne, Maxime (2016). Practice assessment: the PARSEC system. McGill Family Medicine Studies Online, 11: e05. 

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Abstract

Background: Practice assessment (PA) is proposed to be a necessary aspect of clinical governance and quality improvement. However, lacks in causal understanding of its mechanisms is causing unexplained variations in its effect. Informatics has been seen to be invaluable in similar fields although its effect on PA is largely unknown. Future implementation efforts will need guidance on how to develop PA systems and how to operationalize best practices, and current evidence. My objectives are to: (1) identify the barriers to effective audit and feedback interventions in health-care and to suggest how informatics methods implemented in the context of theories of behaviour change can help to overcome these barriers; (2) develop a model capable of supporting the development and administration of electronic PA interventions using findings from barriers to A&F, approaches to behaviour change, and product engineering.

Methods: We used a qualitative, explanatory case-study to identify the barriers to effective A&F intervention and to frame these barriers within the context of informatics methods and behaviour change theories using instances of deployed interventions as cases. Qualitative data was collected from the cases, and these data were subjected to a deductive thematic content analysis. These findings then informed the creation of a generic model of electronic PA. The model was described using a standard of software specification.

Results: The thematic analysis resulted in the identification of six overarching themes regarding barriers to effective PA implementation. These were: resource constraint, adoption, clinical governance, cognitive biases, control theory, and learning culture. A presentation of the models' requirements was then used to describe how instances should be developed, what they must contain, how they should be administered, and what are the activities needed to their deployment.

Conclusion: Although A&F causal mechanisms are still unknown, the use of multiple theoretical perspectives allowed us to identify qualitatively potential barriers influencing its effect on improving quality and health outcomes. These findings suggest that the use of informatics methods an impact large enough to warrant separate evaluation. This shift in paradigm offers hope as to the possibility of achieving greater sustainability, lowering net costs, creating a beneficial culture of quality, and putting in place the foundation of an evidence-based, quality-focused, and accountable primary health care system.