Data Dashboard + Nudge Emails

Data dashboards are a common audit and feedback approach to support changes in processes and behavior. The rural Transitions Nurse Program (TNP) is a care coordination intervention for high-risk Veterans. An interactive dashboard was used to provide real-time performance metrics to sites. The feedback goal was to increase TNP Veteran discharges. One-year post implementation, discharge goals were not met. Control theory suggests that feedback using diverse methods can positively influence performance. Nudge emails can draw attention to performance metrics to improve awareness of current state. This study evaluated whether Veteran discharges and site communication increased when feedback occurred through a dashboard plus weekly nudge email versus dashboard alone.

This observational study reviewed discharge counts of urban, rural, and highly rural Veterans who were hospitalized and discharged from four VA hospitals participating in TNP. Transitions nurses and site champions implementing TNP at each site were surveyed.

Veteran discharge counts during the dashboard phase were compared to discharges during the dashboard plus weekly nudge email phase. The emails included run charts (figure) with site discharge averages and weekly discharge counts. The difference of means for weekly discharges between the two phases was calculated using Poisson distribution. After 3 months of nudge emails, project time was calculated and a survey assessing nurse and champion perceptions of the nudge emails was distributed.

Our sample included four VA medical centers. The average weekly discharges for all sites during the ~20-month dashboard phase was 4.23 Veterans. The weekly average during the 3-month dashboard plus nudge email phase was 4.21 Veterans. The difference in means was -0.03 (p=0.73). Adjusting for time trends had no further effect. Project time to create and communicate nudge emails was ~14 hours over 3 months. Four nurses responded to the survey. Two reported neutral and two reported positive perceptions of the nudge emails. No site champions responded to the survey.

Drawing attention to metrics, through nudge emails, maintained, but did not increase TNP Veteran discharges compared to dashboard feedback alone. These findings suggest the nudge effort has no effect on TNP.