Performance Feedback Improves Compliance With Quality Measures

Am J Med Qual. 2016 Mar-Apr;31(2):118-24. doi: 10.1177/1062860614556089. Epub 2014 Oct 27.


Cirrhotic complications portend high morbidity and mortality and burden the health care system. Established quality measures in management of cirrhotics include screening for esophageal varices (EV), screening for hepatocellular carcinoma (HCC), and hepatitis A and B immunization. A retrospective review was conducted to identify adherence to cirrhosis. Baseline rates were shared with providers. Compliance with quality measures was measured prospectively at 1-month, 2-month, 1-year, and 3-year follow-up after provision of performance feedback. Baseline HCC rate was 60%, EV was 68%, and hepatitis A and B immunization was 51% and 47%, respectively. After performance feedback, HCC, EV, and hepatitis A and B vaccination rates improved to rates ranging from 92% to 100% and remained statistically significant after 3 years. Provider feedback, a simple intervention, achieved significant improvement in compliance with quality measures for management of cirrhotics. This improvement in adherence to quality measures was sustainable over a 3-year time period.

Keywords: cirrhosis; feedback; hepatology; quality improvement.

MeSH terms

  • Carcinoma, Hepatocellular / complications
  • Esophageal and Gastric Varices / complications
  • Esophageal and Gastric Varices / diagnosis
  • Female
  • Formative Feedback*
  • Guideline Adherence / statistics & numerical data*
  • Hepatitis A Vaccines / administration & dosage
  • Hepatitis B Vaccines / administration & dosage
  • Humans
  • Liver Cirrhosis / complications
  • Liver Neoplasms / complications
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Prospective Studies
  • Quality Improvement / organization & administration*
  • Quality Indicators, Health Care
  • Retrospective Studies


  • Hepatitis A Vaccines
  • Hepatitis B Vaccines