What will help doctors improve their patient care?

Women's College Hospital family physician and researcher Dr. Noah Ivers speaks with a patient. Women's College Hospital/Supplied photo

TORONTO – Advice and feedback handed to doctors to help them improve their patient care shows little to no impact, a new Canadian study warns. But its lead researchers caution: it’s not because doctors don’t care, rather it may be because they don’t know how to create change with the information in front of them.

About four times a year, Dr. Noah Ivers receives a handful of reports documenting his patients’ care. He learns about how many of his patients have properly controlled blood pressure, what proportion of seniors are taking meds that may not be recommended for the elderly or how many people may be due for a blood test, for example.

It’s a lot of information that’s doled out to family doctors and specialists. Ivers, a Women’s College Hospital family doctor and University of Toronto scientist, wanted to know what doctors do with this data in hand.

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“It’s all well meaning and I’m seeing various reactions amongst my colleagues from completely ignoring them, to overreacting or feeling emotional distress from those who are really trying their hardest,” Ivers, who specializes in understanding health system management, explained.

“It seemed fairly clear to me that there’s a lot of potential here but this could be done a lot better,” he said.

So in a systematic review he combed through two decades worth of research, documenting the outcome of studies that looked at feedback reports and if they improved the quality of care patients received. Sixty-two studies were included in the review.

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Turns out, these number-crunching reports had a “small, but measureable impact” on quality of care: one quarter of the studies led to no change at all, but 28 per cent showed an improvement of more than 10 per cent, which Ivers called “substantial.”

“[The reports] are not drawing doctors’ attention in a way that would help them improve care or designed in a way that’s actionable. Just because you tell me I’m doing a bad job, it doesn’t mean I know what to do to make it better,” Ivers explained.
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It’s akin to parents receiving a bad report card for their children without any tips on how to resolve the situation, he said. It can be overwhelming, and in some cases, doctors file the reports away because they’re unsure of what to do with them.

Other studies zeroed in on patient feedback handed directly back to doctors. In that case, that information didn’t lead to significant change either.

Ivers suggests the research is timely: right now, gaps in quality care need to be addressed with an aging population adding pressure to the health care system. Taxpayers are calling for more accountability and these days, big data has been touted as a fountain of information for health care officials.

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How can those supplying the reports and doctors arouse change? Ivers is working on it.

For starters, he’s in touch with Cancer Care Ontario, Health Quality Ontario, the Institute for Clinical Evaluative Sciences (ICES) and other organizations that distribute these reports. He’s also interviewing doctors to get a pulse on where they stand.

The study also suggested that feedback is most effective if it’s delivered by a respected colleague, if it’s repeated multiple times, or if it outlines tangible goals and action plans.

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Ivers said that patients shouldn’t be alarmed by his findings. Instead, they should be relieved.

“Patients should be happy that we’re working hard. I don’t know any doctors who aren’t trying their best,” he said.

His next steps are to look at various reports, and if certain styles lead to better results compared to others.

Ivers’ full findings were published Tuesday afternoon in the Journal of General Internal Medicine.

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