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Trial record 1 of 1 for:    NCT02979964
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Pragmatic Factorial Cluster Trial of Framing and Comparators for Audit and Feedback

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Health Quality Ontario
Information provided by (Responsible Party):
Noah Ivers, Women's College Hospital
ClinicalTrials.gov Identifier:
NCT02979964
First received: November 29, 2016
Last updated: December 8, 2016
Last verified: December 2016
  Purpose
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 Intervention
High-risk Prescribing in Nursing Homes Behavioral: Audit and Feedback

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single Blind (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

Resource links provided by NLM:


Further study details as provided by Noah Ivers, Women's College Hospital:

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

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

  • Antipsychotic rates [ Time Frame: 6 months ]
    monthly proportion

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

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

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

  • 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).

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

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

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


Enrollment: 285
Study Start Date: December 2016
Estimated Study Completion Date: December 2017
Estimated Primary Completion Date: June 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
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

  Eligibility

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:

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: 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
  More Information

Additional Information:
Publications:

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
Study First Received: November 29, 2016
Last Updated: December 8, 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: Analyses of outcomes use routine administrative database holdings.

ClinicalTrials.gov processed this record on July 26, 2017