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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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Proportion of residents in the intervention and control groups with moderate to severe pain before, during, and after the feedback intervention.
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Fig3: Proportion of residents in the intervention and control groups with moderate to severe pain before, during, and after the feedback intervention.

Mentions: We initially display the time series as graphs in Figures 2, 3, 4, and 5. These graphs allow the reader to evaluate the absolute levels of the outcomes in each instance, as well as the change over time. In each graph, the blue arrows indicate the beginning and end of the intervention period. In Tables 5 and 6, we summarize the findings from the segmented regression analyses for the intervention and comparison sites, respectively. The Durbin-Watson statistic was significant only for one outcome, falls, in the intervention sites. As a result, we present the Prais-Winsten regression results for falls. The other regression results are all from ordinary least squares regression.Figure 2


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)

Proportion of residents in the intervention and control groups with moderate to severe pain before, during, and after the feedback intervention.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Proportion of residents in the intervention and control groups with moderate to severe pain before, during, and after the feedback intervention.
Mentions: We initially display the time series as graphs in Figures 2, 3, 4, and 5. These graphs allow the reader to evaluate the absolute levels of the outcomes in each instance, as well as the change over time. In each graph, the blue arrows indicate the beginning and end of the intervention period. In Tables 5 and 6, we summarize the findings from the segmented regression analyses for the intervention and comparison sites, respectively. The Durbin-Watson statistic was significant only for one outcome, falls, in the intervention sites. As a result, we present the Prais-Winsten regression results for falls. The other regression results are all from ordinary least squares regression.Figure 2

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