Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Canada.
Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada.
Implement Sci. 2017 Jul 14;12(1):86. doi: 10.1186/s13012-017-0615-7.
Audit and feedback (AF) interventions that leverage routine administrative data offer a scalable and relatively low-cost method to improve processes of care. AF interventions are usually designed to highlight discrepancies between desired and actual performance and to encourage recipients to act to address such discrepancies. Comparing to a regional average is a common approach, but more recipients would have a discrepancy if compared to a higher-than-average level of performance. In addition, how recipients perceive and respond to discrepancies may depend on how the feedback itself is framed. We aim to evaluate the effectiveness of different comparators and framing in feedback on high-risk prescribing in nursing homes.
This is a pragmatic, 2 × 2 factorial, cluster-randomized controlled trial testing variations in the comparator and framing on the effectiveness of quarterly AF in changing high-risk prescribing in nursing homes in Ontario, Canada. We grouped homes that share physicians into clusters and randomized these clusters into the four experimental conditions. Outcomes will be assessed after 6 months; all primary analyses will be by intention-to-treat. The primary outcome (monthly number of high-risk medications received by each patient) will be analysed using a general linear mixed effects regression model. We will present both four-arm and factorial analyses. With 160 clusters and an average of 350 beds per cluster, assuming no interaction and similar effects for each intervention, we anticipate 90% power to detect an absolute mean difference of 0.3 high-risk medications prescribed. A mixed-methods process evaluation will explore potential mechanisms underlying the observed effects, exploring targeted constructs including intention, self-efficacy, outcome expectations, descriptive norms, and goal prioritization. An economic analysis will examine cost-effectiveness analysis from the perspective of the publicly funded health care system.
This protocol describes the rationale and methodology of a trial testing manipulations of theory-informed components of an audit and feedback intervention to determine how to improve an existing intervention and provide generalizable insights for implementation science.
NCT02979964.
利用常规行政数据的审核和反馈（AF）干预措施提供了一种可扩展且相对低成本的方法，可以改善医疗护理流程。AF 干预措施通常旨在突出预期表现和实际表现之间的差异，并鼓励接受者采取行动来解决这些差异。与区域平均值进行比较是一种常见的方法，但与高于平均水平的绩效进行比较，会有更多的接受者存在差异。此外，接受者如何感知和响应差异可能取决于反馈本身的构建方式。我们旨在评估不同比较器和反馈框架在改善安大略省养老院高风险处方方面的效果。
这是一项务实的、2×2 析因、集群随机对照试验，旨在测试比较器和反馈框架的变化对加拿大安大略省养老院季度 AF 改变高风险处方的效果。我们将共享医生的家庭分组为集群，并将这些集群随机分配到四个实验条件中。将在 6 个月后评估结果；所有主要分析均为意向治疗。主要结局（每位患者每月接受的高风险药物数量）将使用一般线性混合效应回归模型进行分析。我们将同时呈现四臂和析因分析。考虑到没有相互作用且每个干预措施的效果相似，我们预计有 160 个集群和每个集群平均 350 个床位，将有 90%的功效来检测出 0.3 种规定的高风险药物的绝对平均差异。一项混合方法的过程评估将探索观察到的效果的潜在机制，探索有针对性的结构，包括意图、自我效能、结果预期、描述性规范和目标优先级。一项经济分析将从公共资助的医疗保健系统的角度考察成本效益分析。
本方案描述了一项试验的原理和方法，该试验旨在测试审核和反馈干预措施中基于理论的组成部分的操作，以确定如何改进现有的干预措施，并为实施科学提供普遍适用的见解。
NCT02979964。
