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The feasibility of automating audit and feedback for ART guideline adherence in Malawi

Lewis, ZL and Mello-Thoms, C and Gadabu, OJ and Gillespie, EM and Douglas, GP and Crowley, RS (2011) The feasibility of automating audit and feedback for ART guideline adherence in Malawi. Journal of the American Medical Informatics Association, 18 (6). 868 - 874. ISSN 1067-5027

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Objective: To determine the feasibility of using electronic medical record (EMR) data to provide audit and feedback of antiretroviral therapy (ART) clinical guideline adherence to healthcare workers (HCWs) in Malawi. Materials and methods: We evaluated recommendations from Malawi's ART guidelines using GuideLine Implementability Appraisal criteria. Recommendations that passed selected criteria were converted into ratio-based performance measures. We queried representative EMR data to determine the feasibility of generating feedback for each performance measure, summed clinical encounters representing each performance measure's denominator, and then measured the distribution of encounter frequency for individual HCWs across nurse and clinical officer groups. Results: We analyzed 423 831 encounters in the EMR data and generated automated feedback for 21 recommendations (12%) from Malawi's ART guidelines. We identified 11 nurse recommendations and eight clinical officer recommendations. Individual nurses and clinical officers had an average of 45 and 59 encounters per month, per recommendation, respectively. Another 37 recommendations (21%) would support audit and feedback if additional routine EMR data are captured and temporal constraints are modeled. Discussion: It appears feasible to implement automated guideline adherence feedback that could potentially improve HCW performance and supervision. Feedback reports may support workplace learning by increasing HCWs' opportunities to reflect on their performance. Conclusion: A moderate number of recommendations from Malawi's ART guidelines can be used to generate automated guideline adherence feedback using existing EMR data. Further study is needed to determine the receptivity of HCWs to peer comparison feedback and barriers to implementation of automated audit and feedback in low-resource settings.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Lewis, ZL
Mello-Thoms, Ccrm1@pitt.eduCRM1
Gadabu, OJ
Gillespie, EM
Douglas, GP
Crowley, RS
Date: 17 November 2011
Date Type: Publication
Journal or Publication Title: Journal of the American Medical Informatics Association
Volume: 18
Number: 6
Page Range: 868 - 874
DOI or Unique Handle: 10.1136/amiajnl-2011-000097
Schools and Programs: School of Medicine > Biomedical Informatics
Refereed: Yes
ISSN: 1067-5027
MeSH Headings: Anti-Retroviral Agents--therapeutic use; Automatic Data Processing; Electronic Health Records; Feasibility Studies; Feedback; Guideline Adherence; Health Personnel; Humans; Malawi; Medical Audit--methods; Practice Guidelines as Topic
Other ID: NLM PMC3197989
PubMed Central ID: PMC3197989
PubMed ID: 21565857
Date Deposited: 29 Aug 2012 20:59
Last Modified: 02 Feb 2019 16:56


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