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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Feedback GAP: Pragmatic, cluster-randomized trial of goal setting and action plans to increase the effectiveness of audit and feedback interventions in primary care
Implementation Science, Volume 8, No. 1, Article 142, Year 2013
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Description
Background: Audit and feedback to physicians is a commonly used quality improvement strategy, but its optimal design is unknown. This trial tested the effects of a theory-informed worksheet to facilitate goal setting and action planning, appended to feedback reports on chronic disease management, compared to feedback reports provided without these worksheets. Methods: A two-arm pragmatic cluster randomized trial was conducted, with allocation at the level of primary care clinics. Participants were family physicians who contributed data from their electronic medical records. The 'usual feedback' arm received feedback every six months for two years regarding the proportion of their patients meeting quality targets for diabetes and/or ischemic heart disease. The intervention arm received these same reports plus a worksheet designed to facilitate goal setting and action plan development in response to the feedback reports. Blood pressure (BP) and low-density lipoprotein cholesterol (LDL) values were compared after two years as the primary outcomes. Process outcomes measured the proportion of guideline-recommended actions (e.g., testing and prescribing) conducted within the appropriate timeframe. Intention-to-treat analysis was performed. Results: Outcomes were similar across groups at baseline. Final analysis included 20 physicians from seven clinics and 1,832 patients in the intervention arm (15% loss to follow up) and 29 physicians from seven clinics and 2,223 patients in the usual feedback arm (10% loss to follow up). Ten of 20 physicians completed the worksheet at least once during the study. Mean BP was 128/72 in the feedback plus worksheet arm and 128/73 in the feedback alone arm, while LDL was 2.1 and 2.0, respectively. Thus, no significant differences were observed across groups in the primary outcomes, but mean haemoglobin A1c was lower in the feedback plus worksheet arm (7.2% versus 7.4%, p<0.001). Improvements in both arms were noted over time for one-half of the process outcomes.Discussion: Appending a theory-informed goal setting and action planning worksheet to an externally produced audit and feedback intervention did not lead to improvements in patient outcomes. The results may be explained in part by passive dissemination of the worksheet leading to inadequate engagement with the intervention.Trial registration: ClinicalTrials.gov NCT00996645. © 2013 Ivers et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Tu, Karen
Canada, Toronto
Institute for Clinical Evaluative Sciences
Canada, Toronto
University of Toronto
Canada, Toronto
West Park Hospital, Toronto
Francis, Jill J.
United Kingdom, London
City, University of London
Barnsley, Jan M.
Canada, Toronto
University of Toronto
Upshur, Ross E.G.
Canada, Toronto
Institute for Clinical Evaluative Sciences
Canada, Toronto
University of Toronto
Moineddin, Rahim
Canada, Toronto
Institute for Clinical Evaluative Sciences
Canada, Toronto
University of Toronto
Grimshaw, Jeremy M.
Canada, Toronto
Institute for Clinical Evaluative Sciences
Canada, Ottawa
Ottawa Hospital Research Institute
Canada, Ottawa
University of Ottawa
Zwarenstein, Merrick F.
Canada, Toronto
Institute for Clinical Evaluative Sciences
Canada, London
Western University
Statistics
Citations: 27
Authors: 7
Affiliations: 9
Identifiers
Doi:
10.1186/1748-5908-8-142
ISSN:
17485908
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Randomised Control Trial