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

Women's College Hospital

Status: Completed

Conditions: High-risk Prescribing in Nursing Homes

Treatments: Behavioral: Audit and Feedback

Study type: Interventional

Funder types: Other

Identifiers

NCT02979964

2016-0122-E

Details and patient eligibility

About

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.

Enrollment: 285 patients

Sex: All

Volunteers: Accepts Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Single Blind

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285 participants in 4 patient groups

Arm 1, Positive Framing

Experimental group

Description:

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.

Treatment:

Behavioral: Audit and Feedback

Arm 2, Negative Framing

Experimental group

Description:

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.

Treatment:

Behavioral: Audit and Feedback

Arm 3, Top Quartile Comparator

Experimental group

Description:

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.

Treatment:

Behavioral: Audit and Feedback

Arm 4, Average Comparator

Experimental group

Description:

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.

Treatment:

Behavioral: Audit and Feedback