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

NCT ID: NCT02979964

Last Updated: 2018-10-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

285 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-12-06

Study Completion Date

2018-07-31

Brief Summary

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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.

Detailed Description

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Conditions

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High-risk Prescribing in Nursing Homes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Arm 1, Positive Framing

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.

Group Type EXPERIMENTAL

Audit and Feedback

Intervention Type BEHAVIORAL

Arm 2, Negative Framing

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.

Group Type EXPERIMENTAL

Audit and Feedback

Intervention Type BEHAVIORAL

Arm 3, Top Quartile Comparator

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.

Group Type EXPERIMENTAL

Audit and Feedback

Intervention Type BEHAVIORAL

Arm 4, Average Comparator

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.

Group Type EXPERIMENTAL

Audit and Feedback

Intervention Type BEHAVIORAL

Interventions

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Audit and Feedback

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* 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

Exclusion Criteria

* n/a
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Health Quality Ontario

OTHER

Sponsor Role collaborator

Women's College Hospital

OTHER

Sponsor Role lead

Responsible Party

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Noah Ivers

M.D., PhD, CCFP

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Noah M Ivers, MD PhD CCFP

Role: PRINCIPAL_INVESTIGATOR

Women's College Hospital - University of Toronto

Locations

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Women's College Hospital

Toronto, Ontario, Canada

Site Status

Countries

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Canada

References

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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.

Reference Type BACKGROUND
PMID: 24438584 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 22696318 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 11401608 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 22161408 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 21091758 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 11708039 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 25070404 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 10461579 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 22456088 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 22530986 (View on PubMed)

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.

Reference Type DERIVED
PMID: 37165413 (View on PubMed)

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.

Reference Type DERIVED
PMID: 28705208 (View on PubMed)

Related Links

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http://www.hqontario.ca/Quality-Improvement/Practice-Reports/Long-Term-Care

Health Quality Ontario Long-Term Care Practice Report

Other Identifiers

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2016-0122-E

Identifier Type: -

Identifier Source: org_study_id

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