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Clinical Practice Guidelines and Impact of Audit and Feedback in the Emergency Department

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02427048
Recruitment Status : Completed
First Posted : April 27, 2015
Last Update Posted : February 2, 2017
Sponsor:
Information provided by (Responsible Party):
Denver Health and Hospital Authority

Brief Summary:
This study will develop and test an intervention given to emergency medicine providers to improve adherence to clinical practice guidelines (CPGs) for pneumonia and sepsis.

Condition or disease Intervention/treatment Phase
Shock, Septic Community Acquired Pneumonia Behavioral: Feedback with Peer Comparison Not Applicable

Detailed Description:

This study will be performed at Denver Health Medical Center, a 477-bed urban, safety-net, acute-care hospital located in Denver, Colorado. The adult ED is staffed by board-certified emergency physicians at all times. These physicians supervise the care of all patients being managed by resident physicians, nurse practitioners, physician assistants, and medical students. Approximately 430 patients are admitted to the hospital from the ED each year with community-acquired pneumonia (CAP) and severe sepsis (SS).

Adherence to CPGs will be measured at the level of the attending emergency physician. All employed, attending emergency physicians working clinically in the adult ED at Denver Health Medical Center at the start of the study will be included.

The investigators will use a step-wedge design to randomize physicians into clusters. Randomization of physicians into clusters and randomization of clusters to intervention timing will occur one week prior to delivery of the intervention to cluster one. he intervention will consist of monthly audit and feedback on adherence to CPGs for CAP and SS. Once a cluster enters its first intervention month, all physicians in that cluster will receive an email detailing their adherence to both CAP and SS CPG for every month since the start of the study. Adherence to the entire CPG as well as each component of the CPG will be provided. In addition, physicians will be shown the median prevalence of adherence for all physicians as well as where their adherence ranks among their physician group. Lastly, in a separate secure email, physicians will be given patient identifiers (i.e., name, MRN, date of visit) for each patient that received non-adherent care and will be told which component of care was not adherent to the respective CPG so that they can review the case themselves, if desired.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 24 participants
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Single (Investigator)
Primary Purpose: Health Services Research
Official Title: Adherence to Clinical Practice Guidelines and the Impact of Audit and Feedback in the Emergency Department
Study Start Date : July 2015
Actual Primary Completion Date : April 2016
Actual Study Completion Date : December 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Pneumonia

Arm Intervention/treatment
No Intervention: Pre-Intervention
Delayed feedback and peer comparison
Experimental: Feedback with Peer Comparison
Individualized adherence feedback with peer comparison
Behavioral: Feedback with Peer Comparison
Email detailing adherence to CAP and SS CPG for every month since start of study. Physicians will be provided individualized feedback and given patient identifiers for each patient that received non-adherent care.




Primary Outcome Measures :
  1. Change in Adherence to Community-Acquired Pneumonia and Severe Sepsis Clinical Practice Guidelines [ Time Frame: 30 days post-intervention and 60 days post-intervention ]
    Adherence will be determined via chart review of patients and will be measured by concordance with published clinical practice guidelines



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   30 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Attending emergency medicine physicians working clinically in the Adult Emergency Department at Denver Health Medical Center at the start of the study.

Exclusion Criteria:

  • None. All eligible physicians will be included.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02427048


Sponsors and Collaborators
Denver Health and Hospital Authority
Investigators
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Principal Investigator: Stacy Trent, MD Denver Health and Hospital Authority
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Responsible Party: Denver Health and Hospital Authority
ClinicalTrials.gov Identifier: NCT02427048    
Other Study ID Numbers: 15-0400
First Posted: April 27, 2015    Key Record Dates
Last Update Posted: February 2, 2017
Last Verified: February 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Denver Health and Hospital Authority:
Clinical Practice Guidelines
Additional relevant MeSH terms:
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Shock, Septic
Pneumonia
Emergencies
Disease Attributes
Pathologic Processes
Lung Diseases
Respiratory Tract Diseases
Respiratory Tract Infections
Sepsis
Infection
Systemic Inflammatory Response Syndrome
Inflammation
Shock