Clinical trial NCT02593253: The Effect of a Novel Audit and Feedback Bundle on Inpatient Performance
Official title: The Effect of a Novel Electronic Physician Audit and Feedback Bundle on Inpatient Performance Metrics
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Quality Improvement
Keywords: Quality Improvement
Quality Indicators, Health Care
Hospital Medicine
Lead sponsor: University of California, San Francisco
Sponsor class: OTHER
First posted: 2015-11-01
Enrollment: 200
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

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.

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.

Eligibility 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

Primary outcomes:
measure: Proportion of patients with a high quality after visit summary
timeFrame: 6 months
measure: Proportion of patients with discharge summary timeliness
timeFrame: 6 months
measure: Proportion of patients Complete Medication Reconciliation by Discharge
timeFrame: 6 months
measure: Proportion of patients achieving a high quality 'perfect' discharge
timeFrame: 6 months
Secondary outcomes:
measure: Proportion of attending and resident physicians who 'strongly agree' that they are satisfied with the audit and feedback of performance data that they receive.
timeFrame: 6 months
measure: Total Phlebotomy Sticks
timeFrame: 6 months
measure: Percent of Patients on Telemetry Until Discharge
timeFrame: 6 months
measure: Proportion of patients discharged by noon
timeFrame: 6 months
Other outcomes:
Locations:
city: San Francisco
country: United States
facility: University of California San Francisco
state: California
Study officials:
affiliation: University of California, San Francisco
name: Alvin R Rajkomar, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Patel S, Rajkomar A, Harrison JD, Prasad PA, Valencia V, Ranji SR, Mourad M. Next-generation audit and feedback for inpatient quality improvement using electronic health record data: a cluster randomised controlled trial. BMJ Qual Saf. 2018 Sep;27(9):691-699. doi: 10.1136/bmjqs-2017-007393. Epub 2018 Mar 5.