A randomised fractional factorial screening experiment to predict effective features of audit and feedback.

Clinical Audit Feedback Health Services Research Humans Intention Medical Audit
Audit and feedback Behaviour change MOST Randomised fractional factorial experiment

Journal

Implementation science : IS
ISSN: 1748-5908
Titre abrégé: Implement Sci
Pays: England
ID NLM: 101258411

Informations de publication

Date de publication:
26 05 2022
Historique:
received: 05 11 2021
accepted: 29 04 2022
entrez: 26 5 2022
pubmed: 27 5 2022
medline: 31 5 2022
Statut: epublish

Résumé

Audit and feedback aims to improve patient care by comparing healthcare performance against explicit standards. It is used to monitor and improve patient care, including through National Clinical Audit (NCA) programmes in the UK. Variability in effectiveness of audit and feedback is attributed to intervention design; separate randomised trials to address multiple questions about how to optimise effectiveness would be inefficient. We evaluated different feedback modifications to identify leading candidates for further "real-world" evaluation. Using an online fractional factorial screening experiment, we randomised recipients of feedback from five UK NCAs to different combinations of six feedback modifications applied within an audit report excerpt: use effective comparators, provide multimodal feedback, recommend specific actions, provide optional detail, incorporate the patient voice, and minimise cognitive load. Outcomes, assessed immediately after exposure to the online modifications, included intention to enact audit standards (primary outcome, ranked on a scale of -3 to +3, tailored to the NCA), comprehension, user experience, and engagement. We randomised 1241 participants (clinicians, managers, and audit staff) between April and October 2019. Inappropriate repeated participant completion occurred; we conservatively excluded participant entries during the relevant period, leaving a primary analysis population of 638 (51.4%) participants. None of the six feedback modifications had an independent effect on intention across the five NCAs. We observed both synergistic and antagonistic effects across outcomes when modifications were combined; the specific NCA and whether recipients had a clinical role had dominant influences on outcome, and there was an antagonistic interaction between multimodal feedback and optional detail. Among clinical participants, predicted intention ranged from 1.22 (95% confidence interval 0.72, 1.72) for the least effective combination in which multimodal feedback, optional detail, and reduced cognitive load were applied within the audit report, up to 2.40 (95% CI 1.88, 2.93) for the most effective combination including multimodal feedback, specific actions, patient voice, and reduced cognitive load. Potentially important synergistic and antagonistic effects were identified across combinations of feedback modifications, audit programmes, and recipients, suggesting that feedback designers must explicitly consider how different features of feedback may interact to achieve (or undermine) the desired effects. International Standard Randomised Controlled Trial Number: ISRCTN41584028.

Sections du résumé

BACKGROUND
Audit and feedback aims to improve patient care by comparing healthcare performance against explicit standards. It is used to monitor and improve patient care, including through National Clinical Audit (NCA) programmes in the UK. Variability in effectiveness of audit and feedback is attributed to intervention design; separate randomised trials to address multiple questions about how to optimise effectiveness would be inefficient. We evaluated different feedback modifications to identify leading candidates for further "real-world" evaluation.
METHODS
Using an online fractional factorial screening experiment, we randomised recipients of feedback from five UK NCAs to different combinations of six feedback modifications applied within an audit report excerpt: use effective comparators, provide multimodal feedback, recommend specific actions, provide optional detail, incorporate the patient voice, and minimise cognitive load. Outcomes, assessed immediately after exposure to the online modifications, included intention to enact audit standards (primary outcome, ranked on a scale of -3 to +3, tailored to the NCA), comprehension, user experience, and engagement.
RESULTS
We randomised 1241 participants (clinicians, managers, and audit staff) between April and October 2019. Inappropriate repeated participant completion occurred; we conservatively excluded participant entries during the relevant period, leaving a primary analysis population of 638 (51.4%) participants. None of the six feedback modifications had an independent effect on intention across the five NCAs. We observed both synergistic and antagonistic effects across outcomes when modifications were combined; the specific NCA and whether recipients had a clinical role had dominant influences on outcome, and there was an antagonistic interaction between multimodal feedback and optional detail. Among clinical participants, predicted intention ranged from 1.22 (95% confidence interval 0.72, 1.72) for the least effective combination in which multimodal feedback, optional detail, and reduced cognitive load were applied within the audit report, up to 2.40 (95% CI 1.88, 2.93) for the most effective combination including multimodal feedback, specific actions, patient voice, and reduced cognitive load.
CONCLUSION
Potentially important synergistic and antagonistic effects were identified across combinations of feedback modifications, audit programmes, and recipients, suggesting that feedback designers must explicitly consider how different features of feedback may interact to achieve (or undermine) the desired effects.
TRIAL REGISTRATION
International Standard Randomised Controlled Trial Number: ISRCTN41584028.

Identifiants

DOI: 10.1186/s13012-022-01208-5 PMID: 35619097 PMC: PMC9137082
pubmed: 35619097
doi: 10.1186/s13012-022-01208-5
pii: 10.1186/s13012-022-01208-5
pmc: PMC9137082
doi:

Types de publication

Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

34

Informations de copyright

© 2022. The Author(s).

Références

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Auteurs

Alexandra Wright-Hughes (A)

Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK. a.wright-hughes@leeds.ac.uk.
ORCID: 0000-0001-8839-6756

Thomas A Willis (TA)

Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.

Stephanie Wilson (S)

Centre for Human-Computer Interaction Design, City, University of London, London, UK.

Ana Weller (A)

Centre for Human-Computer Interaction Design, City, University of London, London, UK.

Fabiana Lorencatto (F)

Centre for Behaviour Change, University College London, London, UK.

Mohamed Althaf (M)

Centre for Human-Computer Interaction Design, City, University of London, London, UK.

Valentine Seymour (V)

Centre for Human-Computer Interaction Design, City, University of London, London, UK.

Amanda J Farrin (AJ)

Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.

Jillian Francis (J)

School of Health Sciences, University of Melbourne, Melbourne, Australia.
Ottawa Hospital Research Institute, Ottawa, Canada.

Jamie Brehaut (J)

Ottawa Hospital Research Institute, Ottawa, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.

Noah Ivers (N)

Department of Family and Community Medicine, Womens College Hospital, University of Toronto, Toronto, Canada.

Sarah L Alderson (SL)

Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.

Benjamin C Brown (BC)

Centre for Health Informatics, University of Manchester, Manchester, UK.
Centre for Primary Care, University of Manchester, Manchester, UK.

Richard G Feltbower (RG)

Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK.

Chris P Gale (CP)

Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK.
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Simon J Stanworth (SJ)

Transfusion Medicine, NHS Blood and Transplant (NHSBT), Oxford, UK.
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
NIHR Oxford Biomedical Research Centre, Oxford, UK.

Suzanne Hartley (S)

Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.

Heather Colquhoun (H)

Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.

Justin Presseau (J)

Ottawa Hospital Research Institute, Ottawa, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.

Rebecca Walwyn (R)

Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.

Robbie Foy (R)

Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.

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Classifications MeSH

questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Assurance de la qualité des soins de santé › Audit clinique › A randomised fractional factorial screening...
questionsmedicales.fr › Sciences de l'information › Analyse des systèmes › Recherche opérationnelle › Rétroaction › A randomised fractional factorial screening...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Recherche sur les services de santé › A randomised fractional factorial screening...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A randomised fractional factorial screening...
questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Intention › A randomised fractional factorial screening...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Assurance de la qualité des soins de santé › Audit clinique › Audit médical › A randomised fractional factorial screening...