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A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies.

Springer MV, Sales AE, Islam N, McBride AC, Landis-Lewis Z, Tupper M, Corches CL, Robles MC, Skolarus LE. A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies. Implementation science : IS. 2021 Apr 1; 16(1):35.

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BACKGROUND: Audit and feedback (AandF) is a widely used implementation strategy. Understanding mechanisms of action of AandF increases the likelihood that the strategy will lead to implementation of an evidence-based practice. We therefore sought to understand one hospital''s experience selecting and implementing an AandF intervention, to determine the implementation strategies that were used by staff and to specify the mechanism of action of those implementation strategies using causal pathway models, with the ultimate goal of improving acute stroke treatment practices. METHODS: We selected an AandF strategy in a hospital, initially based on implementation determinants and staff consideration of their performance on acute stroke treatment measures. After 7 months of AandF, we conducted semi-structured interviews of hospital providers and administrative staff to understand how it contributed to implementing guideline-concordant acute stroke treatment (medication named tissue plasminogen activator). We coded the interviews to identify the implementation strategies that staff used following AandF and to assess their mechanisms of action. RESULTS: We identified five implementation strategies that staff used following the feedback intervention. These included (1) creating folders containing the acute stroke treatment protocol for the emergency department, (2) educating providers about the protocol for acute stroke, (3) obtaining computed tomography imaging of stroke patients immediately upon emergency department arrival, (4) increasing access to acute stroke medical treatment in the emergency department, and (5) providing additional staff support for implementation of the protocol in the emergency department. We identified enablement, training, and environmental restructuring as mechanisms of action through which the implementation strategies acted to improve guideline-concordant and timely acute stroke treatment. CONCLUSIONS: AandF of a hospital''s acute stroke treatment practices generated additional implementation strategies that acted through various mechanisms of action. Future studies should focus on how initial implementation strategies can be amplified through internal mechanisms.

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