Pragmatic Factorial Cluster Trial of Framing and Comparators for Audit and Feedback Aiming to Address High Risk Prescribing in Nursing Homes in Ontario
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 285
- 试验地点
- 2
- 主要终点
- CNS-active medication prescribing
研究概览
简要总结
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Health Services Research
- 盲法
- Single (Outcomes Assessor)
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •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
排除标准
- 未提供
研究组 & 干预措施
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.
干预措施: Audit and Feedback (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.
干预措施: Audit and Feedback (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.
干预措施: Audit and Feedback (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.
干预措施: Audit and Feedback (Behavioral)
结局指标
主要结局
CNS-active medication prescribing
时间窗: 6 months
monthly number of CNS-active medications per resident (antipsychotics, opioids, benzodiazepines or antidepressants (including TCAs and trazodone))
次要结局
- Mean Antipsychotic dose(6 months)
- Benzodiazepine (or z-drug) prescribing(6 months)
- Benzodiazepine (or z-drug) rates(6 months)
- Antipsychotic rates(6 months)
- Antipsychotic prescribing(6 months)
- Mean Benzodiazepine dose(6 months)
- 3+ CNS-active medications(6 months)
- Anti-depressant prescribing(6 months)
- Anti-acid prescribing(6 months)
- Statin prescribing(6 months)
研究者
Noah Ivers
M.D., PhD, CCFP
Women's College Hospital