Pragmatic Factorial Cluster Trial of Framing and Comparators for Audit and Feedback

NCT02979964 | Completed

• 1 other identifier: 2016-0122-E
• Study Type: interventional
• Target: 285
• Locations: 1 country
• Sites: 1

Brief Summary

Health Quality Ontario (HQO) is the provincial advisor on quality in health care. HQO currently conducts audit and feedback as a key quality improvement strategy. For example, it offers physicians working in long-term care homes with access to practice reports detailing rates of high-risk prescribing in comparison with others in Ontario and suggested change ideas. Research shows that providing this kind of feedback can lead to improvements in care. However, the size of these improvements depends how the feedback is presented. For instance, prior research suggests that how the results are 'framed' and what sort of benchmark the recipient is compared to may each affect how the physician will respond. This factorial trial tests each of these aspects of feedback design in the context of practice reports that nursing home physicians have already signed up to receive quarterly.

Conditions

High-risk Prescribing in Nursing Homes

Outcome Measures

Primary Outcomes (1)

• CNS-active medication prescribing

  monthly number of CNS-active medications per resident (antipsychotics, opioids, benzodiazepines or antidepressants (including TCAs and trazodone))

  6 months

Secondary Outcomes (10)

• Benzodiazepine (or z-drug) prescribing

  6 months

• Benzodiazepine (or z-drug) rates

  6 months

• Antipsychotic rates

  6 months

• Antipsychotic prescribing

  6 months

• Mean Antipsychotic dose

  6 months

Study Arms (4)

Arm 1, Positive Framing

EXPERIMENTAL

All metrics in the audit and feedback practice reports presented with 'positive' framing, where the proportion of patients safe from risk (i.e., appropriate/desirable prescribing behaviours) is described.

Behavioral: Audit and Feedback

Arm 2, Negative Framing

EXPERIMENTAL

All metrics in the audit and feedback practice reports presented with 'negative' framing, where the proportion of patients at risk (i.e., due to inappropriate/undesirable prescribing behaviours) is described.

Behavioral: Audit and Feedback

Arm 3, Top Quartile Comparator

EXPERIMENTAL

All metrics in the audit and feedback practice reports presented and the physician-recipient's performance is compared against the 75th percentile for performance by physicians working in nursing homes in the province for each metric.

Behavioral: Audit and Feedback

Arm 4, Average Comparator

EXPERIMENTAL

All metrics in the audit and feedback practice reports presented and the physician-recipient's performance is compared against the average performance by physicians working in nursing homes in the province for each metric.

Behavioral: Audit and Feedback

Interventions

Audit and Feedback BEHAVIORAL

Arm 1, Positive Framing; Arm 2, Negative Framing; Arm 3, Top Quartile Comparator; Arm 4, Average Comparator

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• a physician licensed by the College of Physicians and Surgeons of Ontario (CPSO);
• practice in at least one LTC facility in Ontario;.
• have voluntarily signed up to receive an HQO practice report

You may not qualify if:

• n/a

Sponsors & Collaborators

• Women's College Hospital: lead
• Health Quality Ontario: collaborator

Study Sites (1)

Women's College Hospital

Toronto, Ontario, M5S1B2, Canada

Location

Related Publications (12)

• Ivers NM, Sales A, Colquhoun H, Michie S, Foy R, Francis JJ, Grimshaw JM. No more 'business as usual' with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci. 2014 Jan 17;9:14. doi: 10.1186/1748-5908-9-14.

  PMID: 24438584 BACKGROUND

• Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Jun 13;2012(6):CD000259. doi: 10.1002/14651858.CD000259.pub3.

  PMID: 22696318 BACKGROUND

• Kiefe CI, Allison JJ, Williams OD, Person SD, Weaver MT, Weissman NW. Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial. JAMA. 2001 Jun 13;285(22):2871-9. doi: 10.1001/jama.285.22.2871.

  PMID: 11401608 BACKGROUND

• Akl EA, Oxman AD, Herrin J, Vist GE, Terrenato I, Sperati F, Costiniuk C, Blank D, Schunemann H. Framing of health information messages. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD006777. doi: 10.1002/14651858.CD006777.pub2.

  PMID: 22161408 BACKGROUND

• Kluger AN, Van Dijk D. Feedback, the various tasks of the doctor, and the feedforward alternative. Med Educ. 2010 Dec;44(12):1166-74. doi: 10.1111/j.1365-2923.2010.03849.x.

  PMID: 21091758 BACKGROUND

• Hibbard JH, Peters E, Slovic P, Finucane ML, Tusler M. Making health care quality reports easier to use. Jt Comm J Qual Improv. 2001 Nov;27(11):591-604. doi: 10.1016/s1070-3241(01)27051-5.

  PMID: 11708039 BACKGROUND

• Gould NJ, Lorencatto F, Stanworth SJ, Michie S, Prior ME, Glidewell L, Grimshaw JM, Francis JJ. Application of theory to enhance audit and feedback interventions to increase the uptake of evidence-based transfusion practice: an intervention development protocol. Implement Sci. 2014 Jul 29;9:92. doi: 10.1186/s13012-014-0092-1.

  PMID: 25070404 BACKGROUND

• Weissman NW, Allison JJ, Kiefe CI, Farmer RM, Weaver MT, Williams OD, Child IG, Pemberton JH, Brown KC, Baker CS. Achievable benchmarks of care: the ABCs of benchmarking. J Eval Clin Pract. 1999 Aug;5(3):269-81. doi: 10.1046/j.1365-2753.1999.00203.x.

  PMID: 10461579 BACKGROUND

• Li AC, Kannry JL, Kushniruk A, Chrimes D, McGinn TG, Edonyabo D, Mann DM. Integrating usability testing and think-aloud protocol analysis with "near-live" clinical simulations in evaluating clinical decision support. Int J Med Inform. 2012 Nov;81(11):761-72. doi: 10.1016/j.ijmedinf.2012.02.009. Epub 2012 Mar 27.

  PMID: 22456088 BACKGROUND

• Cane J, O'Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012 Apr 24;7:37. doi: 10.1186/1748-5908-7-37.

  PMID: 22530986 BACKGROUND

• McCleary N, Desveaux L, Presseau J, Reis C, Witteman HO, Taljaard M, Linklater S, Thavorn K, Dobell G, Mulhall CL, Lam JMC, Grimshaw JM, Ivers NM. Engagement is a necessary condition to test audit and feedback design features: results of a pragmatic, factorial, cluster-randomized trial with an embedded process evaluation. Implement Sci. 2023 May 10;18(1):13. doi: 10.1186/s13012-023-01271-6.

  PMID: 37165413 DERIVED

• Ivers NM, Desveaux L, Presseau J, Reis C, Witteman HO, Taljaard MK, McCleary N, Thavorn K, Grimshaw JM. Testing feedback message framing and comparators to address prescribing of high-risk medications in nursing homes: protocol for a pragmatic, factorial, cluster-randomized trial. Implement Sci. 2017 Jul 14;12(1):86. doi: 10.1186/s13012-017-0615-7.

  PMID: 28705208 DERIVED

Related Links

• Health Quality Ontario Long-Term Care Practice Report

Study Officials

• Noah M Ivers, MD PhD CCFP

  Women's College Hospital - University of Toronto

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: M.D., PhD, CCFP

Study Record Dates

• First Submitted: November 29, 2016
• First Posted: December 2, 2016
• Study Start: December 6, 2016
• Primary Completion: October 6, 2017
• Study Completion: July 1, 2018
• Last Updated: October 5, 2018

Record last verified: 2018-10

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)