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The Effect of a Novel Audit and Feedback Bundle on Inpatient Performance

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ClinicalTrials.gov Identifier: NCT02593253
Recruitment Status : Completed
First Posted : November 1, 2015
Last Update Posted : May 9, 2017
Sponsor:
Information provided by (Responsible Party):
University of California, San Francisco

Study Description
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Brief Summary:
This single-blinded, cluster randomized control trial will assess the effectiveness of an audit and feedback bundle on internal medicine physician performance on selected quality metrics. The feedback bundle includes an electronic dashboard and weekly feedback rounds in which physicians will review their performance. The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance.

Condition or disease Intervention/treatment Phase
Quality Improvement Other: Audit and Feedback Bundle Other: Bi-weekly audit and feedback emails Not Applicable

Detailed Description:
This is a single-blinded, cluster randomized control trial of 48 internal medicine teams (24 teams will be randomized to the intervention arm and and 24 teams randomized to control arm) on inpatient medicine wards. Each team consists of at least 4 members (attending physician, senior resident, two interns). The intervention arm teams will receive the new audit and feedback bundle, which includes access to the electronic dashboard and weekly feedback rounds in which they review their performance on several inpatient quality metrics via the electronic dashboard. The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance on selected quality measures. This primary aim of the trial will be to compare the effectiveness of performance feedback on inpatient quality metrics specifically high quality after visit summary, medical reconciliation and discharge summary timeliness. Other group comparisons will include other inpatient quality metrics and satisfaction with feedback.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 200 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Investigator)
Primary Purpose: Health Services Research
Official Title: The Effect of a Novel Electronic Physician Audit and Feedback Bundle on Inpatient Performance Metrics
Actual Study Start Date : February 2016
Actual Primary Completion Date : December 2016
Actual Study Completion Date : May 2017
Arms and Interventions
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Arm Intervention/treatment
Experimental: Intervention Audit and Feedback Bundle
Access to the electronic dashboard and weekly feedback rounds
 Other: Audit and Feedback Bundle
The intervention arm teams will receive the new audit and feedback bundle, which includes access to the electronic dashboard and weekly feedback rounds in which they review their performance on several inpatient quality metrics via the dashboard.
Active Comparator: Bi-weekly audit and feedback emails
Access to biweekly feedback emails with performance on selected quality measures (current practice).
 Other: Bi-weekly audit and feedback emails
The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance on selected quality measures.


Outcome Measures
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Primary Outcome Measures :
  1. Proportion of patients with a high quality after visit summary [ Time Frame: 6 months ]
    The number of hospital medicine team patients with after visit summaries of high quality divided by the total number hospital medicine team patients with an after visit summary.

  2. Proportion of patients with discharge summary timeliness [ Time Frame: 6 months ]
    The number of discharge summaries completed within 24 hours of discharge for hospital medicine team patients/total number of discharges from hospital medicine with a discharge summary completed

  3. Proportion of patients Complete Medication Reconciliation by Discharge [ Time Frame: 6 months ]
    The total number of patients with an action taken on all home medications divided by the total number of patients on the hospital medicine teaching service.

  4. Proportion of patients achieving a high quality 'perfect' discharge [ Time Frame: 6 months ]
    Proportion of patients who have a high quality after visit summary and a discharge summary completed within 24 of discharge and all medications reconciled by discharge.


Secondary Outcome Measures :
  1. Proportion of attending and resident physicians who 'strongly agree' that they are satisfied with the audit and feedback of performance data that they receive. [ Time Frame: 6 months ]
    Proportion of attending and resident physicians who 'strongly agree' that they are satisfied with the audit and feedback of performance data that they receive. This specific satisfaction item has been developed by the study team.

  2. Total Phlebotomy Sticks [ Time Frame: 6 months ]
    The total number of unique accession numbers for each unique hospitalization of a patient

  3. Percent of Patients on Telemetry Until Discharge [ Time Frame: 6 months ]
    The number of patients on without a discontinue order for telemetry within two hours of their discharge date time divided by the total number of patients on telemetry for hospital medicine teams

  4. Proportion of patients discharged by noon [ Time Frame: 6 months ]
    The number of patients discharged by hospital medicine team attendings by noon (6am-11:59am)/total number of discharges by hospital medicine team attendings


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • All physicians that rotate through internal medicine wards during the study period (teaching attending physicians and internal medicine residents and interns)

Exclusion Criteria:

  • None
Contacts and Locations
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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): NCT02593253


Locations
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United States, California
University of California San Francisco
San Francisco, California, United States, 94143
Sponsors and Collaborators
University of California, San Francisco
Investigators
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Principal Investigator: Alvin R Rajkomar, MD University of California, San Francisco
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: University of California, San Francisco
ClinicalTrials.gov Identifier: NCT02593253    
Other Study ID Numbers: 15-17709
First Posted: November 1, 2015    Key Record Dates
Last Update Posted: May 9, 2017
Last Verified: May 2017
Keywords provided by University of California, San Francisco:
Quality Improvement
Quality Indicators, Health Care
Hospital Medicine