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Pragmatic Factorial Cluster Trial of Framing and Comparators for Audit and Feedback

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ClinicalTrials.gov Identifier: NCT02979964
Recruitment Status : Active, not recruiting
First Posted : December 2, 2016
Last Update Posted : November 9, 2017
Sponsor:
Collaborator:
Health Quality Ontario
Information provided by (Responsible Party):
Noah Ivers, Women's College Hospital

Brief Summary:
Health Quality Ontario (HQO) is the provincial advisor on quality in health care. HQO currently conducts audit and feedback as a key quality improvement strategy. For example, it offers physicians working in long-term care homes with access to practice reports detailing rates of high-risk prescribing in comparison with others in Ontario and suggested change ideas. Research shows that providing this kind of feedback can lead to improvements in care. However, the size of these improvements depends how the feedback is presented. For instance, prior research suggests that how the results are 'framed' and what sort of benchmark the recipient is compared to may each affect how the physician will respond. This factorial trial tests each of these aspects of feedback design in the context of practice reports that nursing home physicians have already signed up to receive quarterly.

Condition or disease Intervention/treatment Phase
High-risk Prescribing in Nursing Homes Behavioral: Audit and Feedback Not Applicable

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 285 participants
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Health Services Research
Official Title: Pragmatic Factorial Cluster Trial of Framing and Comparators for Audit and Feedback Aiming to Address High Risk Prescribing in Nursing Homes in Ontario
Actual Study Start Date : December 6, 2016
Actual Primary Completion Date : October 6, 2017
Estimated Study Completion Date : April 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Nursing Homes
U.S. FDA Resources

Arm Intervention/treatment
Experimental: Arm 1, Positive Framing
All metrics in the audit and feedback practice reports presented with 'positive' framing, where the proportion of patients safe from risk (i.e., appropriate/desirable prescribing behaviours) is described.
Behavioral: Audit and Feedback
Experimental: Arm 2, Negative Framing
All metrics in the audit and feedback practice reports presented with 'negative' framing, where the proportion of patients at risk (i.e., due to inappropriate/undesirable prescribing behaviours) is described.
Behavioral: Audit and Feedback
Experimental: Arm 3, Top Quartile Comparator
All metrics in the audit and feedback practice reports presented and the physician-recipient's performance is compared against the 75th percentile for performance by physicians working in nursing homes in the province for each metric.
Behavioral: Audit and Feedback
Experimental: Arm 4, Average Comparator
All metrics in the audit and feedback practice reports presented and the physician-recipient's performance is compared against the average performance by physicians working in nursing homes in the province for each metric.
Behavioral: Audit and Feedback



Primary Outcome Measures :
  1. CNS-active medication prescribing [ Time Frame: 6 months ]
    monthly number of CNS-active medications per resident (antipsychotics, opioids, benzodiazepines or antidepressants (including TCAs and trazodone))


Secondary Outcome Measures :
  1. Benzodiazepine (or z-drug) prescribing [ Time Frame: 6 months ]
    days supplied (continuous)

  2. Benzodiazepine (or z-drug) rates [ Time Frame: 6 months ]
    monthly proportion

  3. Antipsychotic rates [ Time Frame: 6 months ]
    monthly proportion

  4. Antipsychotic prescribing [ Time Frame: 6 months ]
    days supplied (continuous)

  5. Mean Antipsychotic dose [ Time Frame: 6 months ]
    Dose equivalent of antipsychotic dispensed (continuous)

  6. Mean Benzodiazepine dose [ Time Frame: 6 months ]
    Dose equivalent of benzodiazepine dispensed (continuous)

  7. 3+ CNS-active medications [ Time Frame: 6 months ]
    monthly proportion supplied three or more meds from the following classes: antipsychotics, opioids, benzodiazepines, or antidepressants (including TCAs and trazodone).

  8. Anti-depressant prescribing [ Time Frame: 6 months ]
    days supplied (continuous) - balance measure

  9. Anti-acid prescribing [ Time Frame: 6 months ]
    days supplied (continuous) - tracer outcome

  10. Statin prescribing [ Time Frame: 6 months ]
    days supplied (continuous) - tracer outcome



Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • a physician licensed by the College of Physicians and Surgeons of Ontario (CPSO);
  • practice in at least one LTC facility in Ontario;.
  • have voluntarily signed up to receive an HQO practice report

Exclusion Criteria:


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02979964


Locations
Canada, Ontario
Women's College Hospital
Toronto, Ontario, Canada, M5S1B2
Sponsors and Collaborators
Women's College Hospital
Health Quality Ontario
Investigators
Principal Investigator: Noah M Ivers, MD PhD CCFP Women's College Hospital - University of Toronto

Additional Information:
Publications:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Noah Ivers, M.D., PhD, CCFP, Women's College Hospital
ClinicalTrials.gov Identifier: NCT02979964     History of Changes
Other Study ID Numbers: 2016-0122-E
First Posted: December 2, 2016    Key Record Dates
Last Update Posted: November 9, 2017
Last Verified: November 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: Analyses of outcomes use routine administrative database holdings.