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Table 3 Implementation Quality – Key Informant Data, Sample Quotes

From: A process evaluation of the improving wisely intervention: a peer-to-peer data intervention to reduce overuse in surgery

Domain/Category Theme Quote Participant ID, status
Dose Deliver Reports Annually I think just continuing the program, so you don’t get it [the report] once every decade or once every 5 years, it’ll maybe remind the outliers ‘Oh, they’re still out there' P5, inlier
Quality of Delivery Report was easy to read, understand I thought it was very intuitive, it’s done incredibly well and I think the data is so critical P4, inlier
Expand report to include non- CMS data I have Medicare patients, I operate in a Veterans hospital which is not included. And my privately insured patients were not included. P9, inlier
Include appropriateness use metrics to strengthen data credibility I’m afraid [without appropriateness use criteria] we end up trying to create a top-hat type curve. Then we end up with a very, very narrow window of what is ‘acceptable’ for number of players P11, inlier
Participant Responsiveness Reassurance of being within the mean I really enjoyed looking at the data and seeing how I compared to other surgeons.
You leave your fellowship and nobody is there anymore watching what you do…and so every now and then it’s so nice to just have like some sort of data saying, ‘hey, here’s what you’re doing compared to everyone else, and it seems to be like you’re A-ok, you know?’
P22, inlier
P2, inlier
Support for ACMS as quality improvement leaders Things like this are only going to benefit the community of Mohs surgeons..the Mohs College is at the leading edge of doing this. I think it shows that it’s what’s going to differentiate us from people who have not done an accredited Mohs surgery fellowship P14, inlier
Belief that it’s better to ‘police your own’ We can make changes in our own practices before a regulated body, the government for example, comes and says you know ‘you’re making too much money…we’re going to cut the reimbursement; if we can make changes from within, then we [can] protect ourselves from outside scrutiny P6, inlier
Reach Perception that outlier problem lies with non-college members In my opinion, I suspect that a lot of the overuse of Mohs surgery codes may be practiced by folks who are not members of the Mohs college…maybe we can be looking at it across a specialty – dermatology- and not just Mohs College members. P7, inlier
Perceptions of Impact Improved Awareness of Overuse I think that it’s natural to become more mindful of something if you know that data is being recorded on it. P5, inlier
Potential Unintended Consequences
- Gaming
- Undue pressure
- Compromised patient quality
We have purposefully taken measures to try and minimize our number of levels taken or our stages to the detriment of our patients on many occasions
[Improving Wisely] is a great awareness tool that should [help] people change their practice for the better, or it will make them hide the bad things they’re doing, hide them deeper
Just the other day I did six stages on a patient and I was like ‘you’re killing me’. Like I’m so aware of this, it kills me now. When that happens, it’s like oh my God, this tumor is gonna mess me up
P28, outlier
P1, outlier