Effect of a web-based audit and feedback intervention with outreach visits on the clinical performance of multidisciplinary teams: a cluster-randomized trial in cardiac rehabilitation

Background The objective of this study was to assess the effect of a web-based audit and feedback (A&F) intervention with outreach visits to support decision-making by multidisciplinary teams. Methods We performed a multicentre cluster-randomized trial within the field of comprehensive cardiac r...

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Vydáno v:Implementation science : IS Ročník 11; číslo 1; s. 160
Hlavní autoři: Gude, Wouter T., van Engen-Verheul, Mariëtte M., van der Veer, Sabine N., Kemps, Hareld M. C., Jaspers, Monique W. M., de Keizer, Nicolette F., Peek, Niels
Médium: Journal Article
Jazyk:angličtina
Vydáno: London BioMed Central 09.12.2016
BioMed Central Ltd
Springer Nature B.V
Témata:
Aged
Benchmarks
Biofeedback training
Cardiac patients
Cardiac Rehabilitation - methods
Care and treatment
Cluster Analysis
Decision-making
Feedback
Female
Goal setting
Health Administration
Health Informatics
Health Policy
Health Promotion and Disease Prevention
Health Services Research
Humans
Internet
Male
Medicine
Medicine & Public Health
Multidisciplinary teams
Netherlands
Outcome Assessment, Health Care - methods
Patient Care Team
Patients
Performance evaluation
Planning
Professionals
Public Health
Quality Improvement
Rehabilitation
Surveys and Questionnaires
Netherlands
United Kingdom
Health care
Quality indicators
Guideline adherence
Quality improvement
Feedback
Cardiac rehabilitation
ISSN:1748-5908, 1748-5908
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Shrnutí:Background The objective of this study was to assess the effect of a web-based audit and feedback (A&F) intervention with outreach visits to support decision-making by multidisciplinary teams. Methods We performed a multicentre cluster-randomized trial within the field of comprehensive cardiac rehabilitation (CR) in the Netherlands. Our participants were multidisciplinary teams in Dutch CR centres who were enrolled in the study between July 2012 and December 2013 and received the intervention for at least 1 year. The intervention included web-based A&F with feedback on clinical performance, facilities for goal setting and action planning, and educational outreach visits. Teams were randomized either to receive feedback that was limited to psychosocial rehabilitation (study group A) or to physical rehabilitation (study group B). The main outcome measure was the difference in performance between study groups in 11 care processes and six patient outcomes, measured at patient level. Secondary outcomes included effects on guideline concordance for the four main CR therapies. Results Data from 18 centres (14,847 patients) were analysed, of which 12 centres (9353 patients) were assigned to group A and six (5494 patients) to group B. During the intervention, a total of 233 quality improvement goals was identified by participating teams, of which 49 (21%) were achieved during the study period. Except for a modest improvement in data completeness (4.5% improvement per year; 95% CI 0.65 to 8.36), we found no effect of our intervention on any of our primary or secondary outcome measures. Conclusions Within a multidisciplinary setting, our web-based A&F intervention engaged teams to define local performance improvement goals but failed to support them in actually completing the improvement actions that were needed to achieve those goals. Future research should focus on improving the actionability of feedback on clinical performance and on addressing the socio-technical perspective of the implementation process. Trial registration NTR3251
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ISSN:1748-5908
1748-5908
DOI:10.1186/s13012-016-0516-1