Abstract
BackgroundAudit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units.MethodsINFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides – non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides’ quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument – Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention.DiscussionINFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes.Trial registrationClinicalTrials.gov Identifier: NCT02695836. Date of registration: 24 February 2016
Highlights
Audit and feedback is effective in improving the quality of care
Evaluation of processes in the facilities We will evaluate with the Basic Assisted Feedback (BAF) and Enhanced Assisted Feedback (EAF) managerial care teams: (1) to what extent they achieved the quality improvement goals defined in the workshops, (2) if they were able to apply the planned strategies in practice, (3) barriers and facilitators encountered, and (4) strategies applied to overcome challenges
We will ask participants in each region to sign up for a teleconference focus group session held at varying times to meet the needs of individual schedules
Summary
Audit and feedback is effective in improving the quality of care. methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units. Importance of residential long term care In Western countries, 3-8% of people aged 65 years or older live in nursing homes [1, 2] (e.g., 224 thousand in Canada [3], 1.3 million in the USA [4], and 2.9 million in Europe [1]), and demand for these services will substantially increase [1, 5, 6]. Without dramatic breakthroughs in either prevention or treatment, as the number of frail elderly increases, so will their eventual need for nursing home care
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