Audit and Feedback for Primary Care: a Cluster-randomized Trial

NCT01878370 | Completed

• 1 other identifier: 075-2013
• Study Type: interventional
• Target: 177
• Locations: 1 country
• Sites: 1

Brief Summary

In a previous study, the investigators delivered graphs to family physicians that outlined the proportion of patients with a history of diabetes or heart disease achieving evidence-based quality targets derived from guideline recommendations. A qualitative evaluation found that participating family physicians did not act upon the feedback for two main reasons. First, they felt that targets recommended in guidelines often did not apply for particular patients. Second, they complained that had difficulty using the feedback reports that only provided aggregate level data for clinical action. In this cluster-randomized trial, the investigators test two approaches to conducting audit and feedback that aims to address these issues. The investigators hypothesize that feedback identifying a small number of patients at high-risk for cardiovascular events requiring action will more effectively lead to changes in clinical behavior than feedback identifying all patients not reaching optimal care targets.

Conditions

Diabetes; Hypertension; Ischemic Heart Disease

Outcome Measures

Primary Outcomes (4)

• composite quality score

  The number of best-practice quality indicators that a patient is achieving divided by the number for which they are eligible.

  12 months

• composite high risk score

  The number of high risk indicators a patient meets divided by the number for which they are eligible.

  12 months

• Proportion of patients with perfect composite quality score

  perfect composite quality score is equal to one hundred percent

  12 months

• Proportion of patients with perfect composite high risk score

  perfect composite high risk score is zero

  12 months

Secondary Outcomes (2)

• Blood pressure

  12 months

• cholesterol (LDL)

  12 months

Other Outcomes (1)

• Each metric within the composite scores

  12 months

Study Arms (2)

High risk

EXPERIMENTAL

Feedback reports focusing on the identification and management of patients who appear to have poorly managed diseases and who may require recall into clinic.

Other: High risk

Best Practice

EXPERIMENTAL

Feedback reports focusing on the achievement of optimal care targets for patients with chronic disease.

Other: Best Practice

Interventions

High risk OTHER

Aggregate-level feedback reports focusing on the proportion of patients with hypertension and/or diabetes and/or ischemic heart disease meeting criteria for high-risk sent via courier every six months and available on a password protected website. Family physicians in this arm will also have access through this website to a list of chart numbers identifying those patients at highest risk. Family physicians in Arm 2 are asked to complete a worksheet that also includes goal setting and action planning, but focuses on reducing the number of patients with high-risk criteria and offers some suggested practice-based approaches.

High risk

Best Practice OTHER

Standard, aggregate-level feedback reports focusing on the proportion of patients with hypertension and/or diabetes and/or ischemic heart disease meeting targets sent via courier every six months and available on a password protected website. Family physicians in this arm will also have access through this website to patient-level data to identify patients not achieving optimal quality of care targets. Family physicians in Arm 1 are asked to complete a worksheet that follows continuous quality improvement principles, including setting an aim statement, engagement with team members in the clinic, testing change concepts at first on a small scale, and then scaling up in a effort to spread best practices.

Best Practice

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Family physicians belonging to and sharing data with the Electronic Medical Record Administrative Linked Database in Ontario
• Patients rostered to these family physicians with diabetes or hypertension or ischemic heart disease

You may not qualify if:

• Family physicians without at least two years of Electronic Medical Record data in EMRALD
• Family physicians without at least 100 rostered, active patients

Sponsors & Collaborators

• Sunnybrook Health Sciences Centre: lead
• Institute for Clinical Evaluative Sciences: collaborator
• Canadian Institutes of Health Research (CIHR): collaborator
• Heart and Stroke Foundation of Canada: collaborator

Study Sites (1)

Institute for Clinical Evaluative Sciences

Toronto, Ontario, M4N 3M5, Canada

Location

MeSH Terms

Conditions

Diabetes Mellitus; Hypertension; Myocardial Ischemia

Interventions

Practice Guidelines as Topic

Condition Hierarchy (Ancestors)

Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Vascular Diseases; Cardiovascular Diseases; Heart Diseases

Intervention Hierarchy (Ancestors)

Guidelines as Topic; Quality Assurance, Health Care; Quality of Health Care; Health Services Administration; Health Care Quality, Access, and Evaluation

Study Officials

• Karen Tu, MD MSc

  Institute for Clinical Evaluative Sciences

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 12, 2013
• First Posted: June 14, 2013
• Study Start: June 1, 2013
• Primary Completion: August 1, 2014
• Study Completion: August 1, 2014
• Last Updated: November 24, 2014

Record last verified: 2014-11

Locations

CA (1)