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The Effect of a Novel Audit and Feedback Bundle on Inpatient Performance

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ClinicalTrials.gov Identifier: NCT02593253
Recruitment Status : Completed
First Posted : November 2, 2015
Last Update Posted : May 9, 2017
Sponsor:
Information provided by (Responsible Party):
University of California, San Francisco

Tracking Information
First Submitted Date  ICMJE October 23, 2015
First Posted Date  ICMJE November 2, 2015
Last Update Posted Date May 9, 2017
Actual Study Start Date  ICMJE February 2016
Actual Primary Completion Date December 2016   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: October 29, 2015)
  • Proportion of patients with a high quality after visit summary [ Time Frame: 6 months ]
    The number of hospital medicine team patients with after visit summaries of high quality divided by the total number hospital medicine team patients with an after visit summary.
  • Proportion of patients with discharge summary timeliness [ Time Frame: 6 months ]
    The number of discharge summaries completed within 24 hours of discharge for hospital medicine team patients/total number of discharges from hospital medicine with a discharge summary completed
  • Proportion of patients Complete Medication Reconciliation by Discharge [ Time Frame: 6 months ]
    The total number of patients with an action taken on all home medications divided by the total number of patients on the hospital medicine teaching service.
  • Proportion of patients achieving a high quality 'perfect' discharge [ Time Frame: 6 months ]
    Proportion of patients who have a high quality after visit summary and a discharge summary completed within 24 of discharge and all medications reconciled by discharge.
Original Primary Outcome Measures  ICMJE Same as current
Change History Complete list of historical versions of study NCT02593253 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures  ICMJE
 (submitted: October 30, 2015)
  • Proportion of attending and resident physicians who 'strongly agree' that they are satisfied with the audit and feedback of performance data that they receive. [ Time Frame: 6 months ]
    Proportion of attending and resident physicians who 'strongly agree' that they are satisfied with the audit and feedback of performance data that they receive. This specific satisfaction item has been developed by the study team.
  • Total Phlebotomy Sticks [ Time Frame: 6 months ]
    The total number of unique accession numbers for each unique hospitalization of a patient
  • Percent of Patients on Telemetry Until Discharge [ Time Frame: 6 months ]
    The number of patients on without a discontinue order for telemetry within two hours of their discharge date time divided by the total number of patients on telemetry for hospital medicine teams
  • Proportion of patients discharged by noon [ Time Frame: 6 months ]
    The number of patients discharged by hospital medicine team attendings by noon (6am-11:59am)/total number of discharges by hospital medicine team attendings
Original Secondary Outcome Measures  ICMJE
 (submitted: October 29, 2015)
  • Provider satisfaction with audit and feedback mechanism [ Time Frame: 6 months ]
    Satisfaction with with audit and feedback
  • Total Phlebotomy Sticks [ Time Frame: 6 months ]
    The total number of unique accession numbers for each unique hospitalization of a patient
  • Percent of Patients on Telemetry Until Discharge [ Time Frame: 6 months ]
    The number of patients on without a discontinue order for telemetry within two hours of their discharge date time divided by the total number of patients on telemetry for hospital medicine teams
  • Proportion of patients discharged by noon [ Time Frame: 6 months ]
    The number of patients discharged by hospital medicine team attendings by noon (6am-11:59am)/total number of discharges by hospital medicine team attendings
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE The Effect of a Novel Audit and Feedback Bundle on Inpatient Performance
Official Title  ICMJE The Effect of a Novel Electronic Physician Audit and Feedback Bundle on Inpatient Performance Metrics
Brief Summary This single-blinded, cluster randomized control trial will assess the effectiveness of an audit and feedback bundle on internal medicine physician performance on selected quality metrics. The feedback bundle includes an electronic dashboard and weekly feedback rounds in which physicians will review their performance. The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance.
Detailed Description This is a single-blinded, cluster randomized control trial of 48 internal medicine teams (24 teams will be randomized to the intervention arm and and 24 teams randomized to control arm) on inpatient medicine wards. Each team consists of at least 4 members (attending physician, senior resident, two interns). The intervention arm teams will receive the new audit and feedback bundle, which includes access to the electronic dashboard and weekly feedback rounds in which they review their performance on several inpatient quality metrics via the electronic dashboard. The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance on selected quality measures. This primary aim of the trial will be to compare the effectiveness of performance feedback on inpatient quality metrics specifically high quality after visit summary, medical reconciliation and discharge summary timeliness. Other group comparisons will include other inpatient quality metrics and satisfaction with feedback.
Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Investigator)
Primary Purpose: Health Services Research
Condition  ICMJE Quality Improvement
Intervention  ICMJE
  • Other: Audit and Feedback Bundle
    The intervention arm teams will receive the new audit and feedback bundle, which includes access to the electronic dashboard and weekly feedback rounds in which they review their performance on several inpatient quality metrics via the dashboard.
  • Other: Bi-weekly audit and feedback emails
    The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance on selected quality measures.
Study Arms  ICMJE
  • Experimental: Intervention Audit and Feedback Bundle
    Access to the electronic dashboard and weekly feedback rounds
    Intervention: Other: Audit and Feedback Bundle
  • Active Comparator: Bi-weekly audit and feedback emails
    Access to biweekly feedback emails with performance on selected quality measures (current practice).
    Intervention: Other: Bi-weekly audit and feedback emails
Publications * Patel S, Rajkomar A, Harrison JD, Prasad PA, Valencia V, Ranji SR, Mourad M. Next-generation audit and feedback for inpatient quality improvement using electronic health record data: a cluster randomised controlled trial. BMJ Qual Saf. 2018 Sep;27(9):691-699. doi: 10.1136/bmjqs-2017-007393. Epub 2018 Mar 5.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: October 29, 2015)
200
Original Estimated Enrollment  ICMJE Same as current
Actual Study Completion Date  ICMJE May 2017
Actual Primary Completion Date December 2016   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • All physicians that rotate through internal medicine wards during the study period (teaching attending physicians and internal medicine residents and interns)

Exclusion Criteria:

  • None
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT02593253
Other Study ID Numbers  ICMJE 15-17709
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Responsible Party University of California, San Francisco
Study Sponsor  ICMJE University of California, San Francisco
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Alvin R Rajkomar, MD University of California, San Francisco
PRS Account University of California, San Francisco
Verification Date May 2017

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP