Pragmatic Factorial Cluster Trial of Framing and Comparators for Audit and Feedback
- Conditions
- High-risk Prescribing in Nursing Homes
- Interventions
- Behavioral: Audit and Feedback
- Registration Number
- NCT02979964
- Lead Sponsor
- Women's College Hospital
- Brief Summary
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
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 285
- 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
- n/a
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description Arm 2, Negative Framing Audit and Feedback 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. Arm 3, Top Quartile Comparator Audit and Feedback 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. Arm 4, Average Comparator Audit and Feedback 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. Arm 1, Positive Framing Audit and Feedback 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.
- Primary Outcome Measures
Name Time Method CNS-active medication prescribing 6 months monthly number of CNS-active medications per resident (antipsychotics, opioids, benzodiazepines or antidepressants (including TCAs and trazodone))
- Secondary Outcome Measures
Name Time Method Benzodiazepine (or z-drug) prescribing 6 months days supplied (continuous)
Benzodiazepine (or z-drug) rates 6 months monthly proportion
Antipsychotic rates 6 months monthly proportion
Antipsychotic prescribing 6 months days supplied (continuous)
Mean Antipsychotic dose 6 months Dose equivalent of antipsychotic dispensed (continuous)
Mean Benzodiazepine dose 6 months Dose equivalent of benzodiazepine dispensed (continuous)
3+ CNS-active medications 6 months monthly proportion supplied three or more meds from the following classes: antipsychotics, opioids, benzodiazepines, or antidepressants (including TCAs and trazodone).
Anti-depressant prescribing 6 months days supplied (continuous) - balance measure
Anti-acid prescribing 6 months days supplied (continuous) - tracer outcome
Statin prescribing 6 months days supplied (continuous) - tracer outcome
Trial Locations
- Locations (1)
Women's College Hospital
🇨🇦Toronto, Ontario, Canada