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Data for improvement and clinical excellence: report of an interrupted time series trial of feedback in long-term care.

Sales AE, Schalm C, Baylon MA, Fraser KD - Implement Sci (2014)

Bottom Line: The primary purpose of the Data for Improvement and Clinical Excellence-Long-Term Care (DICE-LTC) project was to assess the effects of a feedback intervention delivered to all direct care providers on resident outcomes.The only outcome that improved during the intervention period was the proportion of residents with high pain scores, which decreased at the beginning of the intervention.The feedback reports, without any other intervention included, did not achieve the desired reduction in proportion of falls and elevated depression scores.

View Article: PubMed Central - PubMed

Affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. salesann@umich.edu.

ABSTRACT

Background: There is considerable evidence about the effectiveness of audit coupled with feedback for provider behavior change, although few feedback interventions have been conducted in long-term care settings. The primary purpose of the Data for Improvement and Clinical Excellence-Long-Term Care (DICE-LTC) project was to assess the effects of a feedback intervention delivered to all direct care providers on resident outcomes. Our objective in this report is to assess the effect of feedback reporting on rates of pain assessment, depression screening, and falls over time.

Methods: The intervention consisted of monthly feedback reports delivered to all direct care providers, facility and unit administrators, and support staff, delivered over 13 months in nine LTC units across four facilities. Data for feedback reports came from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated in LTC facilities throughout Alberta. The primary evaluation used an interrupted time series design with a comparison group (units not included in the feedback intervention) and a comparison condition (pressure ulcers). We used segmented regression analysis to assess the effect of the feedback intervention.

Results: The primary outcome of the study, falls, showed little change over the period of the intervention, except for a small increase in the rate of falls during the intervention period. The only outcome that improved during the intervention period was the proportion of residents with high pain scores, which decreased at the beginning of the intervention. The proportion of residents with high depression scores appeared to worsen during the intervention.

Conclusions: Maintaining all nine units in the study for its 13-month duration was a positive outcome. The feedback reports, without any other intervention included, did not achieve the desired reduction in proportion of falls and elevated depression scores. The survey on intention to change pain assessment practice which was conducted shortly after most of the feedback distribution cycles may have acted as a co-intervention supporting a reduction in pain scores. The processing and delivery of feedback reports could be accomplished at relatively low cost because the data are mandated and could be added to other intervention approaches to support implementation of evidence-based practices.

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Related in: MedlinePlus

Timeline for DICE-LTC.
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Related In: Results  -  Collection

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Fig1: Timeline for DICE-LTC.

Mentions: We did not risk-adjust our outcomes. We were focused on reporting observed data to the staff providing care to residents, and while risk adjustment might be necessary for comparing across units for performance management or reporting purposes, for quality improvement, staff needed to understand the experience of residents in their care. The data used in this summative evaluation are the same as those provided to staff throughout the feedback intervention. We included data from 6 months prior to the start of the feedback intervention, which began in January 2009, as pre-intervention data, and from 6 months after the end of the intervention, as post-intervention data. The timeline in Figure 1 shows the timing of data extraction, feedback report delivery, and post-intervention data.Figure 1


Data for improvement and clinical excellence: report of an interrupted time series trial of feedback in long-term care.

Sales AE, Schalm C, Baylon MA, Fraser KD - Implement Sci (2014)

Timeline for DICE-LTC.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230368&req=5

Fig1: Timeline for DICE-LTC.
Mentions: We did not risk-adjust our outcomes. We were focused on reporting observed data to the staff providing care to residents, and while risk adjustment might be necessary for comparing across units for performance management or reporting purposes, for quality improvement, staff needed to understand the experience of residents in their care. The data used in this summative evaluation are the same as those provided to staff throughout the feedback intervention. We included data from 6 months prior to the start of the feedback intervention, which began in January 2009, as pre-intervention data, and from 6 months after the end of the intervention, as post-intervention data. The timeline in Figure 1 shows the timing of data extraction, feedback report delivery, and post-intervention data.Figure 1

Bottom Line: The primary purpose of the Data for Improvement and Clinical Excellence-Long-Term Care (DICE-LTC) project was to assess the effects of a feedback intervention delivered to all direct care providers on resident outcomes.The only outcome that improved during the intervention period was the proportion of residents with high pain scores, which decreased at the beginning of the intervention.The feedback reports, without any other intervention included, did not achieve the desired reduction in proportion of falls and elevated depression scores.

View Article: PubMed Central - PubMed

Affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. salesann@umich.edu.

ABSTRACT

Background: There is considerable evidence about the effectiveness of audit coupled with feedback for provider behavior change, although few feedback interventions have been conducted in long-term care settings. The primary purpose of the Data for Improvement and Clinical Excellence-Long-Term Care (DICE-LTC) project was to assess the effects of a feedback intervention delivered to all direct care providers on resident outcomes. Our objective in this report is to assess the effect of feedback reporting on rates of pain assessment, depression screening, and falls over time.

Methods: The intervention consisted of monthly feedback reports delivered to all direct care providers, facility and unit administrators, and support staff, delivered over 13 months in nine LTC units across four facilities. Data for feedback reports came from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated in LTC facilities throughout Alberta. The primary evaluation used an interrupted time series design with a comparison group (units not included in the feedback intervention) and a comparison condition (pressure ulcers). We used segmented regression analysis to assess the effect of the feedback intervention.

Results: The primary outcome of the study, falls, showed little change over the period of the intervention, except for a small increase in the rate of falls during the intervention period. The only outcome that improved during the intervention period was the proportion of residents with high pain scores, which decreased at the beginning of the intervention. The proportion of residents with high depression scores appeared to worsen during the intervention.

Conclusions: Maintaining all nine units in the study for its 13-month duration was a positive outcome. The feedback reports, without any other intervention included, did not achieve the desired reduction in proportion of falls and elevated depression scores. The survey on intention to change pain assessment practice which was conducted shortly after most of the feedback distribution cycles may have acted as a co-intervention supporting a reduction in pain scores. The processing and delivery of feedback reports could be accomplished at relatively low cost because the data are mandated and could be added to other intervention approaches to support implementation of evidence-based practices.

Show MeSH
Related in: MedlinePlus