Abstract
BackgroundThe objective of this study was to assess the effect of a web-based audit and feedback (A&F) intervention with outreach visits to support decision-making by multidisciplinary teams.MethodsWe performed a multicentre cluster-randomized trial within the field of comprehensive cardiac rehabilitation (CR) in the Netherlands. Our participants were multidisciplinary teams in Dutch CR centres who were enrolled in the study between July 2012 and December 2013 and received the intervention for at least 1 year. The intervention included web-based A&F with feedback on clinical performance, facilities for goal setting and action planning, and educational outreach visits. Teams were randomized either to receive feedback that was limited to psychosocial rehabilitation (study group A) or to physical rehabilitation (study group B). The main outcome measure was the difference in performance between study groups in 11 care processes and six patient outcomes, measured at patient level. Secondary outcomes included effects on guideline concordance for the four main CR therapies.ResultsData from 18 centres (14,847 patients) were analysed, of which 12 centres (9353 patients) were assigned to group A and six (5494 patients) to group B. During the intervention, a total of 233 quality improvement goals was identified by participating teams, of which 49 (21%) were achieved during the study period. Except for a modest improvement in data completeness (4.5% improvement per year; 95% CI 0.65 to 8.36), we found no effect of our intervention on any of our primary or secondary outcome measures.ConclusionsWithin a multidisciplinary setting, our web-based A&F intervention engaged teams to define local performance improvement goals but failed to support them in actually completing the improvement actions that were needed to achieve those goals. Future research should focus on improving the actionability of feedback on clinical performance and on addressing the socio-technical perspective of the implementation process.Trial registration NTR3251
Highlights
The objective of this study was to assess the effect of a web-based audit and feedback (A&F) intervention with outreach visits to support decision-making by multidisciplinary teams
Considerable non-concordance remained due to organizational and procedural barriers not being addressed because individual clinical decision support (CDS) users considered them beyond their own influence and responsibility [14]. This finding stressed the need for an intervention directed at decision-making processes at the team rather than at an individual level. This coincides with the approach advised by the American Heart Association (AHA) [11], advocating that entire multidisciplinary cardiac rehabilitation (CR) teams should implement coordinated, joint efforts to reinforce the importance of outpatient CR among healthcare systems, providers, and the public [11]
CR is recommended for all patients who have been hospitalized for an acute coronary syndrome (ACS) and for those who have undergone a cardiac intervention [5, 21]
Summary
The objective of this study was to assess the effect of a web-based audit and feedback (A&F) intervention with outreach visits to support decision-making by multidisciplinary teams. Considerable non-concordance remained due to organizational and procedural barriers not being addressed because individual CDS users considered them beyond their own influence and responsibility [14] This finding stressed the need for an intervention directed at decision-making processes at the team rather than at an individual level. This coincides with the approach advised by the American Heart Association (AHA) [11], advocating that entire multidisciplinary CR teams should implement coordinated, joint efforts to reinforce the importance of outpatient CR among healthcare systems, providers, and the public [11]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
