Participant and caregiver perspectives on health feedback from a healthy lifestyle check.

INTRODUCTION: The usual output following health consultations from paediatric services is a clinical letter to the referring professional or primary care provider, with a copy sent to the patient's caregiver. There is little research on how patients and caregivers perceive the letter content. We aimed to: first understand child, young people and caregiver experiences of and preferences for receiving a health feedback letter about the child/young person's health measures within a healthy lifestyle programme; and second to provide a set of recommendations for designing letters to children, young people and their families within a healthy lifestyle programme. METHODS: This qualitative study, informed by Kaupapa Maori principles, included focus groups of children aged 5-11 years and young people aged 12-18 years who were participants in a healthy lifestyle programme in Taranaki, Aotearoa New Zealand and of their respective caregivers (total n = 47). Discussions were audio-recorded, transcribed and analysed using thematic analysis. FINDINGS: Key themes were identified: letters sometimes acted as 'discourses of disempowerment'-some participants experienced a lack of safety, depersonalisation with medical jargon and 'feeling like a number'. Participants described the need for acknowledgement and affirmation in written communication-health feedback should include validation, choice regarding content, respectful tone and a strengths-based approach to health messages. INTERPRETATION: Letters to referrers, copied to families, can be perceived as disempowering, and participant and caregiver perspectives of content should be considered. This study challenges conventional practice in communicating health feedback with broader implications for written communication in healthcare. We propose separate letters aimed at the child/young person and their caregiver that offer choice in the information they receive. The administrative burden of multiple letters can be mitigated by advances in digital health. PATIENT CONTRIBUTION: This study originated in response to feedback from service users that current health feedback was not meeting their needs or expectations. Patient perspectives, especially from children, are rarely considered in the generation of clinic letters from health professionals. Participants were child participants in the community-based clinical service and their caregivers, and care was taken to represent the demographic backgrounds of service users. Collection and interpretation of Maori data were led by researchers who were local community members to ensure prioritisation and preservation of participant voice. Where possible, results are illustrated in the text by direct quotes from participants, whose identities are protected with a pseudonym.

Enhancing self-regulation and learner engagement in L2 speaking: exploring the potential of intelligent personal assistants within a learning-oriented feedback framework.

INTRODUCTION: Developing L2 speaking proficiency can be challenging for learners, particularly when it comes to fostering self-regulation and maintaining engagement. Intelligent Personal Assistants (IPAs) offer a potential solution by providing accessible, interactive language learning opportunities. METHODS: This mixed-methods study investigated the effectiveness of using Google Assistant within a learning-oriented feedback (LOA) framework to enhance L2 speaking proficiency, self-regulation, and learner engagement among 54 university-level EFL learners in China. Convenience sampling assigned participants to either an experimental group (n = 27) using Google Assistant with tailored activities or a control group (n = 27) using traditional methods. The Oral Proficiency Interview (OPI) assessed speaking performance. Self-reported questionnaires measured L2 motivation and the Scale of Strategic Self-Regulation for Speaking English as a Foreign Language (S2RS-EFL) evaluated speaking self-regulation. Additionally, semi-structured interviews with a subsample of the experimental group provided qualitative insights. RESULTS: The Google Assistant group demonstrated a statistically significant improvement in speaking performance compared to the control group. While no significant difference in motivation was found, thematic analysis of interviews revealed perceived benefits of Google Assistant, including increased accessibility, interactivity, and immediate pronunciation feedback. These features likely contributed to a more engaging learning experience, potentially fostering self-regulation development in line with the core principles of LOA. CONCLUSION: This study suggests Google Assistant as a promising supplementary tool for enhancing L2 speaking proficiency, learner autonomy, and potentially self-regulation within an LOA framework. Further research is needed to explore its impact on motivation and optimize engagement strategies.

Crowdsourced Feedback to Improve Resident Physician Error Disclosure Skills: A Randomized Clinical Trial.

Importance: Residents must prepare for effective communication with patients after medical errors. The video-based communication assessment (VCA) is software that plays video of a patient scenario, asks the physician to record what they would say, engages crowdsourced laypeople to rate audio recordings of physician responses, and presents feedback to physicians. Objective: To evaluate the effectiveness of VCA feedback in resident error disclosure skill training. Design, Setting, and Participants: This single-blinded, randomized clinical trial was conducted from July 2022 to May 2023 at 7 US internal medicine and family medicine residencies (10 total sites). Participants were second-year residents attending required teaching conferences. Data analysis was performed from July to December 2023. Intervention: Residents completed 2 VCA cases at time 1 and were randomized to the intervention, an individual feedback report provided in the VCA application after 2 weeks, or to control, in which feedback was not provided until after time 2. Residents completed 2 additional VCA cases after 4 weeks (time 2). Main Outcomes and Measures: Panels of crowdsourced laypeople rated recordings of residents disclosing simulated medical errors to create scores on a 5-point scale. Reports included learning points derived from layperson comments. Mean time 2 ratings were compared to test the hypothesis that residents who had access to feedback on their time 1 performance would score higher at time 2 than those without feedback access. Residents were surveyed about demographic characteristics, disclosure experience, and feedback use. The intervention's effect was examined using analysis of covariance. Results: A total of 146 residents (87 [60.0%] aged 25-29 years; 60 female [41.0%]) completed the time 1 VCA, and 103 (70.5%) completed the time 2 VCA (53 randomized to intervention and 50 randomized to control); of those, 28 (54.9%) reported reviewing their feedback. Analysis of covariance found a significant main effect of feedback between intervention and control groups at time 2 (mean [SD] score, 3.26 [0.45] vs 3.14 [0.39]; difference, 0.12; 95% CI, 0.08-0.48; P = .01). In post hoc comparisons restricted to residents without prior disclosure experience, intervention residents scored higher than those in the control group at time 2 (mean [SD] score, 3.33 [0.43] vs 3.09 [0.44]; difference, 0.24; 95% CI, 0.01-0.48; P = .007). Worse performance at time 1 was associated with increased likelihood of dropping out before time 2 (odds ratio, 2.89; 95% CI, 1.06-7.84; P = .04). Conclusions and Relevance: In this randomized clinical trial, self-directed review of crowdsourced feedback was associated with higher ratings of internal medicine and family medicine residents' error disclosure skill, particularly for those without real-life error disclosure experience, suggesting that such feedback may be an effective way for residency programs to address their requirement to prepare trainees for communicating with patients after medical harm. Trial Registration: ClinicalTrials.gov Identifier: NCT06234085.

Design and Research of the Grasping Force Feedback Mechanism of Flexible Surgical Robots.

BACKGROUND: Robot-assisted microsurgery (RAMS) is gradually becoming the preferred method for some delicate surgical procedures. However, the lack of haptic feedback reduces the safety of the surgery. Surgeons are unable to feel the grasping force between surgical instruments and the patient's tissues, which can easily lead to grasping failure or tissue damage. METHODS: This paper proposes a tendon-driven grasping force feedback mechanism, consisting of a follower hand and a leader hand, to address the lack of grasping force feedback in flexible surgical robots. Considering the friction in the tendon transmission process, a grasping force estimation model is established for the follower hand. The admittance control model is designed for force/position control of the leader hand. RESULTS: Through experimental validation, it has been confirmed that the grasping force sensing range of the follower hand is 0.5-5 N, with a sensing accuracy of 0.3 N. The leader hand is capable of providing feedback forces in the range of 0-5 N, with a static force accuracy of 0.1 N. CONCLUSIONS: The designed mechanism and control strategy can provide the grasping force feedback function. Future work will focus on improving force feedback performance. TRIAL REGISTRATION: This research has no clinical trials.

How is your feedback perceived? An experimental study of anticipated and delayed conversational feedback.

This article presents a different experiment examining the impact of feedback timing on its perception. Dialog sequences, featuring a main speaker's utterance followed by a listener's feedback, were extracted from spontaneous conversations. The original feedback instances were manipulated to be produced earlier, up to 1.5 s in advance, or to be delayed, up to 2 s later. Participants evaluated the feedback acceptability and engagement level of the listener. The findings reveal that 76% of the time feedback remains acceptable regardless of the delay. However, engagement decreases after a 1-s delay while no consistent effect is observed for feedback anticipation.

Feedback and Financial Incentives for Reducing Cell Phone Use While Driving: A Randomized Clinical Trial.

Importance: Handheld phone use while driving is a major factor in vehicle crashes. Scalable interventions are needed to encourage drivers not to use their phones. Objective: To test whether interventions involving social comparison feedback and/or financial incentives can reduce drivers' handheld phone use. Design, Setting, and Participants: In a randomized clinical trial, interventions were administered nationwide in the US via a mobile application in the context of a usage-based insurance program (Snapshot Mobile application). Customers were eligible to be invited to participate in the study if enrolled in the usage-based insurance program for 30 to 70 days. The study was conducted from May 13 to June 30, 2019. Analysis was completed December 22, 2023. Interventions: Participants were randomly assigned to 1 of 6 trial arms for a 7-week intervention period: (1) control; (2) feedback, with weekly push notification about their handheld phone use compared with that of similar others; (3) standard incentive, with a maximum $50 award at the end of the intervention based on how their handheld phone use compared with similar others; (4) standard incentive plus feedback, combining interventions of arms 2 and 3; (5) reframed incentive plus feedback, with a maximum $7.15 award each week, framed as participant's to lose; and (6) doubled reframed incentive plus feedback, a maximum $14.29 weekly loss-framed award. Main Outcome and Measure: Proportion of drive time engaged in handheld phone use in seconds per hour (s/h) of driving. Analyses were conducted with the intention-to-treat approach. Results: Of 17 663 customers invited by email to participate, 2109 opted in and were randomized. A total of 2020 drivers finished the intervention period (68.0% female; median age, 30 [IQR, 25-39] years). Median baseline handheld phone use was 216 (IQR, 72-480) s/h. Relative to control, feedback and standard incentive participants did not reduce their handheld phone use. Standard incentive plus feedback participants reduced their use by -38 (95% CI, -69 to -8) s/h (P = .045); reframed incentive plus feedback participants reduced their use by -56 (95% CI, -87 to -26) s/h (P < .001); and doubled reframed incentive plus feedback participants reduced their use by -42 s/h (95% CI, -72 to -13 s/h; P = .007). The 5 active treatment arms did not differ significantly from each other. Conclusions and Relevance: In this randomized clinical trial, providing social comparison feedback plus incentives reduced handheld phone use while individuals were driving. Trial Registration: ClinicalTrials.gov Identifier: NCT03833219.

Comparative study on the impact of 'Infographic versus video feedback' on enhancing students' clinical skills in basic life support.

BACKGROUND: Effective cardiopulmonary resuscitation (CPR) training for nursing students is crucial for improving patient outcomes in cardiac arrest scenarios. This study assesses the impact of infographic versus video feedback on enhancing nursing students' clinical skills in Basic Life Support (BLS). METHODS: In a randomized controlled setting, 76 nursing students at Torbat Heydariyeh University of Medical Sciences were divided into two groups: one received infographic-based education and the other video feedback training. Pre- and post-intervention assessments measured knowledge and skill retention using validated questionnaires. RESULTS: Post-training, the infographic group showed significantly higher knowledge scores, while the video feedback group exhibited greater improvement in CPR skill performance. No significant differences were noted in pre-training assessment scores between the groups. CONCLUSION: Infographic-based education enhances BLS knowledge retention, and video feedback improves practical CPR skills. This suggests potential benefits of a combined infographic and video feedback approach for optimizing CPR training outcomes, addressing a critical need in medical education.

How to Design Effective Audit and Feedback Interventions With Nurses: A Set of Hypotheses Based on Qualitative and Quantitative Evidence.

OBJECTIVE: To propose practical hypotheses on audit and feedback that support the effectiveness with nurses. BACKGROUND: Audit and feedback interventions have been mainly studied with physicians; however, the processes have been practiced by nurses for years. Nurses' response may differ from that of physicians and other healthcare disciplines because of their roles, power, and the configuration of nursing activities. METHODS: A comparative analysis of the Clinical Performance Feedback Intervention Theory was conducted using nursing-specific empirical data from: 1) a mixed-methods systematic review and 2) a pilot study of audit and feedback with a team of primary care nurses. RESULTS: Researchers hypothesize that audit and feedback interventions are more effective when: 1) feedback emphasizes how it relates to the relational aspect of nursing; 2) indicators are measured and reported at team level; and 3) feedback is provided in a way that highlights benefits to nurses' practice, such as the potential to reduce workload. CONCLUSION: These proposed hypotheses provide concrete guidance to researchers and managers for an effective use of audit and feedback as a quality improvement strategy with nurses.

Keys to successful clinical audit and feedback: essential steps to making impactful improvements in patient care.

ABSTRACT: Up to 40% of care provided to patients is either wasteful or harmful. The practice of audit and feedback can help identify where care can be improved. However, such audits must be executed in a systematic way that engages with clinicians to maximize the impact of feedback, ultimately improving patient outcomes. Currently, audit training is not integrated into formal education pathways and clinicians need guidance to support them in this activity. This paper explores contemporary research, with the aim of providing practical advice for recommendations to maximize the impact of audit and feedback. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A239.

Enhancing Laryngoscopy Mastery: The Impact of Autonomous Practice with Feedback-Providing Simulators.

Mastery learning with fixed end points and variable training time leads to more consistent expertise but is difficult to implement. Here we piloted mastery learning of laryngoscopy with independent practice. 35 learners participated in independent mastery learning on a manikin that provides automated performance feedback. A pre- and postpractice assessment of intubation skills was completed. After an average of 21 minutes of open practice, the percentage of subjects that met mastery criteria improved from 24% to 89% (P < .05). Independent intubation practice with manikin feedback facilitated mastery learning, enhanced procedural education, and may impact clinical care.

Capturing patient feedback to improve healthcare services.

The primary purpose of gathering patient feedback is to listen to, reflect on and act on the feedback to improve patients' experiences, interactions and health outcomes. Nurses use patient feedback to guide person-centred care or to inform healthcare decisions. However, when healthcare services attempt to improve the quality of care, there can be a lack of process clarity, clear measurement and evidence of improvements. This article provides an overview of the strategies used to capture patient feedback and offers guidance on how nurses can make use of such information to promote healthcare improvement.

Making assessment a team sport: a qualitative study of facilitated group feedback in internal medicine residency.

Purpose: Competency-based medical education relies on feedback from workplace-based assessment (WBA) to direct learning. Unfortunately, WBAs often lack rich narrative feedback and show bias towards Medical Expert aspects of care. Building on research examining interactive assessment approaches, the Queen's University Internal Medicine residency program introduced a facilitated, team-based assessment initiative ("Feedback Fridays") in July 2017, aimed at improving holistic assessment of resident performance on the inpatient medicine teaching units. In this study, we aim to explore how Feedback Fridays contributed to formative assessment of Internal Medicine residents within our current model of competency-based training. Method: A total of 53 residents participated in facilitated, biweekly group assessment sessions during the 2017 and 2018 academic year. Each session was a 30-minute facilitated assessment discussion done with one inpatient team, which included medical students, residents, and their supervising attending. Feedback from the discussion was collected, summarized, and documented in narrative form in electronic WBA forms by the program's assessment officer for the residents. For research purposes, verbatim transcripts of feedback sessions were analyzed thematically. Results: The researchers identified four major themes for feedback: communication, intra- and inter-personal awareness, leadership and teamwork, and learning opportunities. Although feedback related to a broad range of activities, it showed strong emphasis on competencies within the intrinsic CanMEDS roles. Additionally, a clear formative focus in the feedback was another important finding. Conclusions: The introduction of facilitated team-based assessment in the Queen's Internal Medicine program filled an important gap in WBA by providing learners with detailed feedback across all CanMEDS roles and by providing constructive recommendations for identified areas for improvement.

Objectif: La formation médicale fondée sur les compétences s'appuie sur la rétroaction faite lors de l'évaluation des apprentissages par observation directe dans le milieu de travail. Malheureusement, les évaluations dans le milieu de travail omettent souvent de fournir une rétroaction narrative exhaustive et privilégient les aspects des soins relevant de l'expertise médicale. En se basant sur la recherche ayant étudié les approches d'évaluation interactive, le programme de résidence en médecine interne de l'Université Queen's a introduit en juillet 2017 une initiative d'évaluation facilitée et en équipe (« Les vendredis rétroaction ¼), visant à améliorer l'évaluation holistique du rendement des résidents dans les unités d'enseignement clinique en médecine interne. Dans cette étude, nous visons à explorer comment ces « vendredis rétroaction ¼ ont contribué à l'évaluation formative des résidents en médecine interne dans le cadre de notre modèle actuel de formation axée sur les compétences. Méthode: Au total, 53 résidents ont participé à des séances d'évaluation de groupe facilitées et bi-hebdomadaires au cours de l'année universitaire 2017-2018. Chaque séance consistait en une discussion d'évaluation facilitée de 30 minutes menée avec une équipe de l'unité de soins, qui comprenait des étudiants en médecine, des résidents et le médecin superviseur. Les commentaires issus de la discussion ont été recueillis, résumés et documentés sous forme narrative dans des formulaires électroniques d'observation directe dans le milieu de travail par le responsable de l'évaluation du programme de résidence. À des fins de recherche, les transcriptions verbatim des séances de rétroaction ont été analysées de façon thématique. Résultats: Les chercheurs ont identifié quatre thèmes principaux pour les commentaires : la communication, la conscience intra- et interpersonnelle, le leadership et le travail d'équipe, et les occasions d'apprentissage. Bien que la rétroaction concerne un large éventail d'activités, elle met fortement l'accent sur les compétences liées aux rôles intrinsèques de CanMEDS. De plus, le fait que la rétroaction avait un rôle clairement formatif est une autre constatation importante. Conclusions: L'introduction de l'évaluation en équipe facilitée dans le programme de médecine interne à Queen's a comblé une lacune importante dans l'apprentissage par observation directe dans le milieu de travail en fournissant aux apprenants une rétroaction détaillée sur tous les rôles CanMEDS et en formulant des recommandations constructives sur les domaines à améliorer.

Audit and feedback to change diagnostic image ordering practices: A systematic review and meta-analysis.

BACKGROUND: Up to 30% of diagnostic imaging (DI) tests may be unnecessary, leading to increased healthcare costs and the possibility of patient harm. The primary objective of this systematic review was to assess the effect of audit and feedback (AF) interventions directed at healthcare providers on reducing image ordering. The secondary objective was to examine the effect of AF on the appropriateness of DI ordering. METHODS: Studies were identified using MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov registry on December 22nd, 2022. Studies were included if they were randomized control trials (RCTs), targeted healthcare professionals, and studied AF as the sole intervention or as the core component of a multi-faceted intervention. Risk of bias for each study was evaluated using the Cochrane risk of bias tool. Meta-analyses were completed using RevMan software and results were displayed in forest plots. RESULTS: Eleven RCTs enrolling 4311 clinicians or practices were included. AF interventions resulted in 1.5 fewer image test orders per 1000 patients seen than control interventions (95% confidence interval (CI) for the difference -2.6 to -0.4, p-value = 0.009). The effect of AF on appropriateness was not statistically significant, with a 3.2% (95% CI -1.5 to 7.7%, p-value = 0.18) greater likelihood of test orders being considered appropriate with AF vs control interventions. The strength of evidence was rated as moderate for the primary objective but was very low for the appropriateness outcome because of risk of bias, inconsistency in findings, indirectness, and imprecision. CONCLUSION: AF interventions are associated with a modest reduction in total DI ordering with moderate certainty, suggesting some benefit of AF. Individual studies document effects of AF on image order appropriateness ranging from a non-significant trend toward worsening to a highly significant improvement, but the weighted average effect size from the meta-analysis is not statistically significant with very low certainty.

Feedback in an Entrustment-Based Objective Structured Clinical Examination: Analysis of Content and Scoring Methods.

Background The integration of entrustable professional activities (EPAs) within objective structured clinical examinations (OSCEs) has yielded a valuable avenue for delivering timely feedback to residents. However, concerns about feedback quality persist. Objective This study aimed to assess the quality and content alignment of verbal feedback provided by examiners during an entrustment-based OSCE. Methods We conducted a progress test OSCE for internal medicine residents in 2022, assessing 7 EPAs. The immediate 2-minute feedback provided by examiners was recorded and analyzed using the Quality of Assessment of Learning (QuAL) score. We also analyzed the degree of alignment with EPA learning objectives: competency milestones and task-specific abilities. In a randomized crossover experiment, we compared the impact of 2 scoring methods used to assess residents' clinical performance (3-point entrustability scales vs task-specific checklists) on feedback quality and alignment. Results Twenty-one examiners provided feedback to 67 residents. The feedback demonstrated high quality (mean QuAL score 4.3 of 5) and significant alignment with the learning objectives of the EPAs. On average, examiners addressed in their feedback 2.5 milestones (61%) and 1.2 task-specific abilities (46%). The scoring methods used had no significant impact on QuAL scores (95% CI -0.3, 0.1, P=.28), alignment with competency milestones (95% CI -0.4, 0.1, P=.13), or alignment with task-specific abilities (95% CI -0.3, 0.1, P=.29). Conclusions In our entrustment-based OSCE, examiners consistently offered valuable feedback aligned with intended learning outcomes. Notably, we explored high-quality feedback and alignment as separate dimensions, finding no significant impact from our 2 scoring methods on either aspect.

Longitudinal evaluation of an electronic audit and feedback system for patient safety in a large tertiary hospital setting.

Objective: This study sought to assess the impact of a novel electronic audit and feedback (e-A&F) system on patient outcomes. Methods: The e-A&F intervention was implemented in a tertiary hospital and involved near real-time feedback via web-based dashboards. We used a segmented regression analysis of interrupted time series. We modelled the pre-post change in outcomes for the (1) announcement of this priority list, and (2) implementation of the e-A&F intervention to have affected patient outcomes. Results: Across the study period there were 222,792 episodes of inpatient care, of which 13,904 episodes were found to contain one or more HACs, a risk of 6.24%. From the point of the first intervention until the end of the study the overall risk of a HAC reduced from 8.57% to 4.12% - a 51.93% reduction. Of this reduction the proportion attributed to each of these interventions was found to be 29.99% for the announcement of the priority list and 21.93% for the implementation of the e-A&F intervention. Discussion: Our findings lend evidence to a mechanism that the announcement of a measurement framework, at a national level, can lead to local strategies, such as e-A&F, that lead to significant continued improvements over time.

Characterizing the aggregated encoding method utilizing bursts activated by a VCSEL-neuron with a feedback structure.

The rapid advancement of photonic technologies has facilitated the development of photonic neurons that emulate neuronal functionalities akin to those observed in the human brain. Neuronal bursts frequently occur in behaviors where information is encoded and transmitted. Here, we present the demonstration of the bursting response activated by an artificial photonic neuron. This neuron utilizes a single vertical-cavity surface-emitting laser (VCSEL) and encodes multiple stimuli effectively by varying the spike count during a burst based on the polarization competition in the VCSEL. By virtue of the modulated optical injection in the VCSEL employed to trigger the spiking response, we activate bursts output in the VCSEL with a feedback structure in this scheme. The bursting response activated by the VCSEL-neuron exhibits neural signal characteristics, promising an excitation threshold and the refractory period. Significantly, this marks the inaugural implementation of a controllable integrated encoding scheme predicated on bursts within photonic neurons. There are two remarkable merits; on the one hand, the interspike interval of bursts is distinctly diminished, amounting to merely one twenty-fourth compared to that observed in optoelectronic oscillators. Moreover, the interspike period of bursts is about 70.8% shorter than the period of spikes activated by a VCSEL neuron without optical feedback. Our results may shed light on the analogy between optical and biological neurons and open the door to fast burst encoding-based optical systems with a speed several orders of magnitude faster than their biological counterparts.

Tunable linear feedback control of urban drainage systems using models defined purely from data.

Real-time and model-predictive control promises to make urban drainage systems (UDS) adaptive, coordinated, and dynamically optimal. Though early implementations are promising, existing control algorithms have drawbacks in computational expense, trust, system-level coordination, and labor cost. Linear feedback control has distinct advantages in computational expense, interpretation, and coordination. However, current methods for building linear feedback controllers require calibrated software models. Here we present an automated method for generating tunable linear feedback controllers that require only system response data. The controller design consists of three main steps: (1) estimating the network connectivity using tools for causal inference, (2) identifying a linear, time-invariant (LTI) dynamical system which approximates the network, and (3) designing and tuning a feedback controller based on the LTI urban drainage system approximation. The flooding safety, erosion prevention, and water treatment performance of the method are evaluated across 190 design storms on a separated sewer model. Strong results suggest that the system knowledge required for generating effective, safe, and tunable controllers for UDS is surprisingly basic. This method allows near-turnkey synthesis of controllers solely from sensor data or reduction of process-based models.

Practice Facilitation and Clinical Performance Feedback Using the Electronic Health Record Improved Blood Pressure and Cholesterol Management in Small Primary Care Practices in New York City.

Cardiovascular disease (CVD) disproportionately affects people of color and those with lower household income. Improving blood pressure (BP) and cholesterol management for those with or at risk for CVD can improve health outcomes. The New York City Department of Health implemented clinical performance feedback with practice facilitation (PF) in 134 small primary care practices serving on average over 84% persons of color. Facilitators reviewed BP and cholesterol management data on performance dashboards and guided practices to identify and outreach to patients with suboptimal BP and cholesterol management. Despite disruptions from the COVID-19 pandemic, practices demonstrated significant improvements in BP (68%-75%, P < .001) and cholesterol management (72%-78%, P = .01). Prioritizing high-need neighborhoods for impactful resource investment, such as PF and data sharing, may be a promising approach to reducing CVD and hypertension inequities in areas heavily impacted by structural racism.