Cargando…
A randomised fractional factorial screening experiment to predict effective features of audit and feedback
BACKGROUND: Audit and feedback aims to improve patient care by comparing healthcare performance against explicit standards. It is used to monitor and improve patient care, including through National Clinical Audit (NCA) programmes in the UK. Variability in effectiveness of audit and feedback is attr...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9137082/ https://www.ncbi.nlm.nih.gov/pubmed/35619097 http://dx.doi.org/10.1186/s13012-022-01208-5 |
_version_ | 1784714302938152960 |
---|---|
author | Wright-Hughes, Alexandra Willis, Thomas A. Wilson, Stephanie Weller, Ana Lorencatto, Fabiana Althaf, Mohamed Seymour, Valentine Farrin, Amanda J. Francis, Jillian Brehaut, Jamie Ivers, Noah Alderson, Sarah L. Brown, Benjamin C. Feltbower, Richard G. Gale, Chris P. Stanworth, Simon J. Hartley, Suzanne Colquhoun, Heather Presseau, Justin Walwyn, Rebecca Foy, Robbie |
author_facet | Wright-Hughes, Alexandra Willis, Thomas A. Wilson, Stephanie Weller, Ana Lorencatto, Fabiana Althaf, Mohamed Seymour, Valentine Farrin, Amanda J. Francis, Jillian Brehaut, Jamie Ivers, Noah Alderson, Sarah L. Brown, Benjamin C. Feltbower, Richard G. Gale, Chris P. Stanworth, Simon J. Hartley, Suzanne Colquhoun, Heather Presseau, Justin Walwyn, Rebecca Foy, Robbie |
author_sort | Wright-Hughes, Alexandra |
collection | PubMed |
description | BACKGROUND: Audit and feedback aims to improve patient care by comparing healthcare performance against explicit standards. It is used to monitor and improve patient care, including through National Clinical Audit (NCA) programmes in the UK. Variability in effectiveness of audit and feedback is attributed to intervention design; separate randomised trials to address multiple questions about how to optimise effectiveness would be inefficient. We evaluated different feedback modifications to identify leading candidates for further “real-world” evaluation. METHODS: Using an online fractional factorial screening experiment, we randomised recipients of feedback from five UK NCAs to different combinations of six feedback modifications applied within an audit report excerpt: use effective comparators, provide multimodal feedback, recommend specific actions, provide optional detail, incorporate the patient voice, and minimise cognitive load. Outcomes, assessed immediately after exposure to the online modifications, included intention to enact audit standards (primary outcome, ranked on a scale of −3 to +3, tailored to the NCA), comprehension, user experience, and engagement. RESULTS: We randomised 1241 participants (clinicians, managers, and audit staff) between April and October 2019. Inappropriate repeated participant completion occurred; we conservatively excluded participant entries during the relevant period, leaving a primary analysis population of 638 (51.4%) participants. None of the six feedback modifications had an independent effect on intention across the five NCAs. We observed both synergistic and antagonistic effects across outcomes when modifications were combined; the specific NCA and whether recipients had a clinical role had dominant influences on outcome, and there was an antagonistic interaction between multimodal feedback and optional detail. Among clinical participants, predicted intention ranged from 1.22 (95% confidence interval 0.72, 1.72) for the least effective combination in which multimodal feedback, optional detail, and reduced cognitive load were applied within the audit report, up to 2.40 (95% CI 1.88, 2.93) for the most effective combination including multimodal feedback, specific actions, patient voice, and reduced cognitive load. CONCLUSION: Potentially important synergistic and antagonistic effects were identified across combinations of feedback modifications, audit programmes, and recipients, suggesting that feedback designers must explicitly consider how different features of feedback may interact to achieve (or undermine) the desired effects. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: ISRCTN41584028 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13012-022-01208-5. |
format | Online Article Text |
id | pubmed-9137082 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-91370822022-05-28 A randomised fractional factorial screening experiment to predict effective features of audit and feedback Wright-Hughes, Alexandra Willis, Thomas A. Wilson, Stephanie Weller, Ana Lorencatto, Fabiana Althaf, Mohamed Seymour, Valentine Farrin, Amanda J. Francis, Jillian Brehaut, Jamie Ivers, Noah Alderson, Sarah L. Brown, Benjamin C. Feltbower, Richard G. Gale, Chris P. Stanworth, Simon J. Hartley, Suzanne Colquhoun, Heather Presseau, Justin Walwyn, Rebecca Foy, Robbie Implement Sci Research BACKGROUND: Audit and feedback aims to improve patient care by comparing healthcare performance against explicit standards. It is used to monitor and improve patient care, including through National Clinical Audit (NCA) programmes in the UK. Variability in effectiveness of audit and feedback is attributed to intervention design; separate randomised trials to address multiple questions about how to optimise effectiveness would be inefficient. We evaluated different feedback modifications to identify leading candidates for further “real-world” evaluation. METHODS: Using an online fractional factorial screening experiment, we randomised recipients of feedback from five UK NCAs to different combinations of six feedback modifications applied within an audit report excerpt: use effective comparators, provide multimodal feedback, recommend specific actions, provide optional detail, incorporate the patient voice, and minimise cognitive load. Outcomes, assessed immediately after exposure to the online modifications, included intention to enact audit standards (primary outcome, ranked on a scale of −3 to +3, tailored to the NCA), comprehension, user experience, and engagement. RESULTS: We randomised 1241 participants (clinicians, managers, and audit staff) between April and October 2019. Inappropriate repeated participant completion occurred; we conservatively excluded participant entries during the relevant period, leaving a primary analysis population of 638 (51.4%) participants. None of the six feedback modifications had an independent effect on intention across the five NCAs. We observed both synergistic and antagonistic effects across outcomes when modifications were combined; the specific NCA and whether recipients had a clinical role had dominant influences on outcome, and there was an antagonistic interaction between multimodal feedback and optional detail. Among clinical participants, predicted intention ranged from 1.22 (95% confidence interval 0.72, 1.72) for the least effective combination in which multimodal feedback, optional detail, and reduced cognitive load were applied within the audit report, up to 2.40 (95% CI 1.88, 2.93) for the most effective combination including multimodal feedback, specific actions, patient voice, and reduced cognitive load. CONCLUSION: Potentially important synergistic and antagonistic effects were identified across combinations of feedback modifications, audit programmes, and recipients, suggesting that feedback designers must explicitly consider how different features of feedback may interact to achieve (or undermine) the desired effects. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: ISRCTN41584028 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13012-022-01208-5. BioMed Central 2022-05-26 /pmc/articles/PMC9137082/ /pubmed/35619097 http://dx.doi.org/10.1186/s13012-022-01208-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Wright-Hughes, Alexandra Willis, Thomas A. Wilson, Stephanie Weller, Ana Lorencatto, Fabiana Althaf, Mohamed Seymour, Valentine Farrin, Amanda J. Francis, Jillian Brehaut, Jamie Ivers, Noah Alderson, Sarah L. Brown, Benjamin C. Feltbower, Richard G. Gale, Chris P. Stanworth, Simon J. Hartley, Suzanne Colquhoun, Heather Presseau, Justin Walwyn, Rebecca Foy, Robbie A randomised fractional factorial screening experiment to predict effective features of audit and feedback |
title | A randomised fractional factorial screening experiment to predict effective features of audit and feedback |
title_full | A randomised fractional factorial screening experiment to predict effective features of audit and feedback |
title_fullStr | A randomised fractional factorial screening experiment to predict effective features of audit and feedback |
title_full_unstemmed | A randomised fractional factorial screening experiment to predict effective features of audit and feedback |
title_short | A randomised fractional factorial screening experiment to predict effective features of audit and feedback |
title_sort | randomised fractional factorial screening experiment to predict effective features of audit and feedback |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9137082/ https://www.ncbi.nlm.nih.gov/pubmed/35619097 http://dx.doi.org/10.1186/s13012-022-01208-5 |
work_keys_str_mv | AT wrighthughesalexandra arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT willisthomasa arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT wilsonstephanie arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT wellerana arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT lorencattofabiana arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT althafmohamed arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT seymourvalentine arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT farrinamandaj arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT francisjillian arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT brehautjamie arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT iversnoah arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT aldersonsarahl arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT brownbenjaminc arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT feltbowerrichardg arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT galechrisp arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT stanworthsimonj arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT hartleysuzanne arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT colquhounheather arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT presseaujustin arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT walwynrebecca arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT foyrobbie arandomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT wrighthughesalexandra randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT willisthomasa randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT wilsonstephanie randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT wellerana randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT lorencattofabiana randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT althafmohamed randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT seymourvalentine randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT farrinamandaj randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT francisjillian randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT brehautjamie randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT iversnoah randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT aldersonsarahl randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT brownbenjaminc randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT feltbowerrichardg randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT galechrisp randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT stanworthsimonj randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT hartleysuzanne randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT colquhounheather randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT presseaujustin randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT walwynrebecca randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback AT foyrobbie randomisedfractionalfactorialscreeningexperimenttopredicteffectivefeaturesofauditandfeedback |