Study protocol
Evaluating the effectiveness of a tailored multifaceted performance feedback intervention to improve the quality of care: protocol for a cluster randomized trial in intensive care
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* Corresponding author: Sabine N van der Veer s.n.vanderveer@amc.nl
1 Department of Medical Informatics, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, the Netherlands
2 Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, PO Box 90153, 5000 LE Tilburg, the Netherlands
3 Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, the Netherlands
4 Onze Lieve Vrouwe Gasthuis, Department of Intensive Care, PO Box 95500, 1090 HM Amsterdam, the Netherlands
5 IQ Scientific Institute for Quality of Healthcare, UMC St Radboud, PO Box 9101 - 114, 6500 HB Nijmegen, the Netherlands
6 Directorate General for Health and Consumers, European Commission, B - 1049 Brussels, Belgium
Implementation Science 2011, 6:119 doi:10.1186/1748-5908-6-119
Published: 24 October 2011Abstract
Background
Feedback is potentially effective in improving the quality of care. However, merely sending reports is no guarantee that performance data are used as input for systematic quality improvement (QI). Therefore, we developed a multifaceted intervention tailored to prospectively analyzed barriers to using indicators: the Information Feedback on Quality Indicators (InFoQI) program. This program aims to promote the use of performance indicator data as input for local systematic QI. We will conduct a study to assess the impact of the InFoQI program on patient outcome and organizational process measures of care, and to gain insight into barriers and success factors that affected the program's impact. The study will be executed in the context of intensive care. This paper presents the study's protocol.
Methods/design
We will conduct a cluster randomized controlled trial with intensive care units (ICUs) in the Netherlands. We will include ICUs that submit indicator data to the Dutch National Intensive Care Evaluation (NICE) quality registry and that agree to allocate at least one intensivist and one ICU nurse for implementation of the intervention. Eligible ICUs (clusters) will be randomized to receive basic NICE registry feedback (control arm) or to participate in the InFoQI program (intervention arm). The InFoQI program consists of comprehensive feedback, establishing a local, multidisciplinary QI team, and educational outreach visits. The primary outcome measures will be length of ICU stay and the proportion of shifts with a bed occupancy rate above 80%. We will also conduct a process evaluation involving ICUs in the intervention arm to investigate their actual exposure to and experiences with the InFoQI program.
Discussion
The results of this study will inform those involved in providing ICU care on the feasibility of a tailored multifaceted performance feedback intervention and its ability to accelerate systematic and local quality improvement. Although our study will be conducted within the domain of intensive care, we believe our conclusions will be generalizable to other settings that have a quality registry including an indicator set available.
Trial registration
Current Controlled Trials ISRCTN50542146