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

Abstract

BackgroundFeedback 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/designWe 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.DiscussionThe 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 registrationCurrent Controlled Trials ISRCTN50542146

Process evaluation of a tailored multifaceted feedback program to improve the quality of intensive care by using quality indicators

“…The InFoQI program is a multifaceted intervention for the ICU setting, tailored to barriers identified prospectively and developed using evidence from literature, input by future users and expert knowledge 16. InFoQI aimed to promote the use of performance indicator data for systematic QI at ICUs.…”

“…To evaluate the impact of the InFoQI program on the quality of ICU care, we conducted a cluster randomised trial in the Netherlands from January 2009 until January 2011 16 18 19. ICUs were eligible for InFoQI if they participated in the NICE registry (n=80), were preparing to submit performance indicator data to the registry (n=46) and were able to allocate at least two staff members to form the QI team.…”

“…Therefore, a barrier analysis was performed in Dutch ICUs with regard to the standard NICE feedback reports. This analysis showed that Dutch ICU healthcare professionals perceived several barriers to using performance data for systematic quality improvement (QI) 16 17. Based on these results, we developed the Information Feedback on Quality Indicators (InFoQI) program, which is described in the Methods section 16.…”

“…This analysis showed that Dutch ICU healthcare professionals perceived several barriers to using performance data for systematic quality improvement (QI) 16 17. Based on these results, we developed the Information Feedback on Quality Indicators (InFoQI) program, which is described in the Methods section 16. The effectiveness of this program was evaluated in a cluster randomised trial 16.…”

“…Based on these results, we developed the Information Feedback on Quality Indicators (InFoQI) program, which is described in the Methods section 16. The effectiveness of this program was evaluated in a cluster randomised trial 16. In this trial, we evaluated the impact of applying for 1 year the InFoQI program on the patient outcomes ICU length of stay, mechanical ventilation duration, glucose regulation and all-cause hospital mortality as well as the impact on the organisational process measures bed occupancy rate and nurse-to-patient ratio 18 19…”