Effect of Enhanced Feedback to Hospitals in an Emerging Clinical Information Network

Not Applicable

Completed

• Conditions: Pneumonia
• Interventions: Behavioral: Enhanced feedback; Behavioral: Standard feedback

• Registration Number: NCT02817971
• Lead Sponsor: KEMRI-Wellcome Trust Collaborative Research Program

Brief Summary

A cluster randomised pragmatic trial will be conducted within an emerging clinical information network composed of 12 Kenyan county hospitals. Hospitals will be randomised to an enhanced feedback intervention delivered over a nine-month period and compared to standard feedback. The trial to be implemented during a phase of implementing change in guideline recommendations for pneumonia will assess the impact of enhanced feedback on hospital uptake of the revised pneumonia treatment recommendations.

Detailed Description

The international guidelines for the classification and treatment of childhood pneumonia were revised recently and in Kenya the national guidelines changed in February 2016. We designed an enhanced feedback intervention aimed at improving uptake of the revised pneumonia treatment policy within a clinical network of 12 Kenyan county referral hospitals.

Hospitals were randomized to receive either enhanced feedback (n = 6 hospitals) or standard feedback (n = 6 hospitals) delivered over a six-month period following nationwide pneumonia treatment policy change. The primary outcome is the proportion of all pneumonia admissions (fulfilling criteria for treatment with oral amoxicillin) who are correctly classified and treated using new guideline recommendations. The proportion of treatment change from oral amoxicillin to alternative antibiotics for pneumonia (considered a proxy measure of treatment failure) will be reported as a secondary outcome.

Study Timeline

• Study Start: 2016-03
• Study First Submitted: 2016-06-27
• Study First Submitted QC: 2016-06-28
• Study First Posted: 2016-06-29
• Primary Completion: 2016-12
• Study Completion: 2016-12
• Status Verified: 2017-07
• Last Update Submitted: 2017-07-20
• Last Update Posted: 2017-07-24

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 900

Inclusion Criteria

• Children aged 2 to 59 months admitted to participating network hospitals with WHO pneumonia diagnosis eligible for treatment with oral amoxicillin

Exclusion Criteria

• Children aged 2 to 59 months with WHO pneumonia diagnosis and co-morbid illnesses requiring intravenous antibiotic treatment including severe acute malnutrition, bacteraemia, meningitis, or
• children presenting with pneumonia and tuberculosis or cough lasting more than 2 weeks, or severe malaria

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Enhanced feedback	Enhanced feedback	1. Monthly written feedback incorporating goal setting, and action planning delivered by a senior clinical coordinator for selected pneumonia indicators 2. Two-monthly written feedback on multiple quality of paediatric care indicators 3. Clinical network promoting clinical leadership linked to mentorship and peer to peer support 4. Improved use of health information on service delivery
Standard feedback	Standard feedback	1. Two-monthly written feedback on multiple quality of paediatric care indicators 2. Clinical network promoting clinical leadership linked to mentorship and peer to peer support 3. Improved use of health information on service delivery

Primary Outcome Measures

Name	Time	Method
Pneumonia classification and treatment	9 months	The proportion of all pneumonia admissions (fulfilling criteria for treatment with oral amoxicillin) who are correctly classified and treated using new guideline recommendations

Secondary Outcome Measures

Name	Time	Method
Antibiotic change	9 months	The proportion of treatment change from oral amoxicillin to alternative antibiotics for pneumonia (considered a proxy measure of treatment failure)

Trial Locations

Locations (12)

Busia County Hospital; 🇰🇪 Busia, Kenya

Embu County Hospital; 🇰🇪 Embu, Kenya

Kakamega County Referral Hospital; 🇰🇪 Kakamega, Kenya

Vihiga County Hospital; 🇰🇪 Kakamega, Kenya

Karatina County Hospital; 🇰🇪 Karatina, Kenya

Kerugoya County Hospital; 🇰🇪 Kerugoya, Kenya

Kiambu County Hospital; 🇰🇪 Kiambu, Kenya

Kisumu County Hospital; 🇰🇪 Kisumu, Kenya

Kitale County Hospital; 🇰🇪 Kitale, Kenya

Mama Lucy Kibaki Hospital; 🇰🇪 Nairobi, Kenya

Machakos County Hospital; 🇰🇪 Machakos, Kenya

Nyeri County Hospital; 🇰🇪 Nyeri, Kenya