Diabetes Mellitus is a common, disabling and deadly condition. The management of diabetes is used, nationally and internationally, as an exemplar for chronic disease management reform and improvement. Audit and feedback (A&F) is an effective quality improvement technique that has been applied across a range of conditions, including diabetes. However, less is known about how to design and deliver feedback to maximise usability, support evidence-based practice and improve outcomes for patients. Using an established audit cycle for diabetes in general practice, we will evaluate the usability of an electronic feedback report for GPs and practice nurses through a user-centred design (UCD) process. The feedback report will be developed and tested iteratively, drawing on GP and practice nurse preferences, theory, and evidence of best practice.
The research will be conducted in practices enrolled in the Diabetes in General Practice Initiative (DiGP) comprising 86 practices engaged in A&F. First, a rapid evidence review will identify international examples of clinical performance feedback to inform the development of a paper-based prototype report. Next, focus groups and interviews with general practice clinicians (n=20-25 participants) will be conducted to elicit their preferences. Using these findings, researchers will work with general practice, design and engineering collaborators to refine the prototype to be embedded in the GP software. User testing following a “Think aloud” protocol will be conducted with 4-6 practices, whereby GPs and practice nurses will verbalise their thoughts as they react to the feedback report. The results will be used to further refine the electronic prototype and produce a user preferences guide for A&F in general practice.
Drawing on our team’s track record in diabetes research and leveraging an existing audit cycle, this project will produce a theoretically-informed and evidence-based performance feedback report that will be implementable in general practice.
