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 rehabilitationReport as inadecuate




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Implementation Science

, 11:160

First Online: 09 December 2016Received: 14 March 2016Accepted: 24 October 2016DOI: 10.1186-s13012-016-0516-1

Cite this article as: Gude, W.T., van Engen-Verheul, M.M., van der Veer, S.N. et al. Implementation Sci 2016 11: 160. doi:10.1186-s13012-016-0516-1

Abstract

BackgroundThe objective of this study was to assess the effect of a web-based audit and feedback AandF intervention with outreach visits to support decision-making by multidisciplinary teams.

MethodsWe 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 AandF 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.

ResultsData 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.

ConclusionsWithin a multidisciplinary setting, our web-based AandF 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 registrationNTR3251

KeywordsQuality improvement Quality indicators Health care Cardiac rehabilitation Guideline adherence Feedback  Download fulltext PDF



Author: Wouter T. Gude - Mariëtte M. van Engen-Verheul - Sabine N. van der Veer - Hareld M. C. Kemps - Monique W. M. Jaspers

Source: https://link.springer.com/







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