Effects of audit and feedback on professional practice in Geriatric Acute Care Units

Abstract

PurposeTo evaluate the effects of audit and feedback on service delivery and patient functioning in Austrian Geriatric Acute Care Units. MethodsQuality initiative based on a standardised documentation form (core and optional data set) and a web-based performance feedback with peer comparison in 18 Geriatric Acute Care Units, representing 40% of all Austrian units. Main outcome measures were compliance with desired practice of geriatric care (comprehensive geriatric assessment [CGA], therapeutic consequences), discharge characteristics and mortality. ResultsOverall 22,279 patient records were documented between 2008 and 2010. Active involvement in the web-based feedback system was indicated by a high frequency of data queries per year, 1401, 3148 and 2883 for 2008, 2009 and 2010, respectively. The mean completion rate for CGA tests increased from 73% in 2008 to 78% in 2010 (P<0.05). For centres with completion of core and optional data (n=8), the average number of documented therapeutic interventions increased from 4.4 to 5.0 (P<0.05). Those aspects of CGA focusing on activities of daily living, mobility and cognition prompted the greatest degree of corresponding therapeutic interventions (>90%). A lower intervention rate was induced by the nutritional assessment (<20%). Mortality and discharge characteristics such as level of care and percentage of patients living at home after discharge did not change over the time. ConclusionFollowing implementation of a web-based performance feedback with peer comparison in Austrian Geriatric Acute Care Units, an improvement in health care professionals’ compliance with desired practice of geriatric care, but not in patients’ discharge characteristics, was observed.