Unregulated provider perceptions of audit and feedback reports in long-term care: cross-sectional survey findings from a quality improvement intervention

Kimberly D Fraser,Anne E Sales,Hannah M O’Rourke,Anne-Marie Boström,Melba Andrea B Baylon

doi:10.1186/1471-2318-13-15

Abstract

BackgroundAudit with feedback is a moderately effective approach for improving professional practice in other health care settings. Although unregulated caregivers give the majority of direct care in long-term care settings, little is known about how they understand and perceive feedback reports because unregulated providers have not been directly targeted to receive audit with feedback in quality improvement interventions in long-term care. The purpose of this paper is to describe unregulated care providers’ perceptions of usefulness of a feedback report in four Canadian long-term care facilities.MethodsWe delivered monthly feedback reports to unregulated care providers for 13 months in 2009–2010. The feedback reports described a unit’s performance in relation to falls, depression, and pain as compared to eight other units in the study. Follow-up surveys captured participant perceptions of the feedback report. We conducted descriptive analyses of the variables related to participant perceptions and multivariable logistic regression to assess the association between perceived usefulness of the feedback report and a set of independent variables.ResultsThe vast majority (80%) of unregulated care providers (n = 171) who responded said they understood the reports. Those who discussed the report with others and were interested in other forms of data were more likely to find the feedback report useful for making changes in resident care.ConclusionsThis work suggests that unregulated care providers can understand and feel positively about using audit with feedback reports to make changes to resident care. Further research should explore ways to promote fuller engagement of unregulated care providers in decision-making to improve quality of care in long-term care settings.

Highlights

Audit with feedback is a moderately effective approach for improving professional practice in other health care settings
Unregulated care providers had worked an average of ten years within LTC settings (s.d. 8.58; range 0 to 35) and an average of five years within their current long-term care unit (s.d. 5.01; range 0 to 22)
We found that unregulated providers in LTC settings express both an ability to understand feedback reports presented as part of a quality improvement intervention, and perceive that these reports provide them with information that is useful for changing resident care

Summary

Introduction

Audit with feedback is a moderately effective approach for improving professional practice in other health care settings. A current trend in caring for older Canadians experiencing functional or cognitive decline (or both) is to provide supportive care within a person’s home or in an assisted living setting for as long as possible [9]. This “aging in place” approach (8), along with supporting individuals and families for as long as possible within community settings, is emphasized in numerous Canadian jurisdictions [1,9], including Alberta [10]. In Alberta in 2008, 14,500 seniors or persons with disabilities (or 0.40% of the province’s population), lived in a LTC facility [10,11]

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