Optimizing Audit and Feedback for Primary Care
Condition: Diabetes Mellitus, Type 2; Coronary Artery Disease
MeSH terms: Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      There remains a large gap between ideal and actual care provided to patients with chronic
      diseases. Performance feedback reports are often used as a foundation for quality improvement
      interventions. There have been hundreds of trials investigating the use of feedback reports;
      the important question to ask now is not whether performance feedback reports can help to
      improve quality of care, but how to optimize feedback interventions to accomplish that goal.
      The purpose of this study is to test whether a theory-based intervention added to feedback
      reports sent to primary care providers can result in improved outcomes for patients with
      chronic disease.
    

Detailed description: 
      There remains a large gap between ideal and actual care provided to patients with chronic
      diseases such as type-2 diabetes (DM2) and coronary artery disease (CAD), making them a
      common focus for translational research. Quality improvement strategies such as audit and
      feedback, which can increase adoption and adherence to guidelines, may be a good choice for
      such problems. Audit and feedback is felt to be effective because it may overcome physicians'
      limited ability to accurately self-assess. A recent Cochrane review concluded that it may
      increase appropriate clinical practice by 5 to 10 percentage points. However, the authors
      noted great variability in the results of the trials. It is thought that optimal design and
      delivery of feedback will more consistently lead to improved results, but few studies have
      tested different designs of feedback. A more recent meta-analysis of feedback found that
      interventions incorporating theoretical principles from psychology in the design were more
      effective than intuitive feedback designs. The author of that study has urged the creation of
      more 'actionable' feedback. There is both theoretical and empirical reason to believe that
      feedback will be more effective if the recipients set goals and develop action plans.

      A group of family physicians across Ontario have previously signed data sharing agreements
      with ICES allowing their electronic medical records to be audited. These physicians will be
      invited to participate in this trial. Participants will receive performance feedback reports
      summarizing the percentage of their DM2 and CAD patients who are meeting evidence-based
      targets for quality of care.

      Participating physicians will be split into two groups at the level of their practice to
      reduce risk of contamination. Minimization software will be used to ensure balance at
      baseline in the primary outcomes between the intervention and control group. New potential
      participants that have signed data sharing agreements at ICES will be invited to join the
      trial for a maximum of six months after the first practices are allocated.

      The intervention group will receive in addition to the feedback reports a theoretically
      informed worksheet meant to facilitate goal-setting and the development of action plans. This
      will occur every six months for two years. Outcomes will be analyzed after 24 months.
    

Intervention name(s): Worksheet to facilitate goal-setting and action plans
Intervention type(s): Other
Intervention description(s): Developed based on goal-setting theory and implementation intentions, the worksheet will be mailed out with the feedback reports and is expected to facilitate improved quality of care in response to feedback reports.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Diabetes Mellitus, Type 2; Coronary Artery Disease; Primary Health Care; Feedback, Psychological; Quality Assurance, Health Care