Quality ImprovementNCT02593253
The Effect of a Novel Audit and Feedback Bundle on Inpatient Performance
A study testing Audit and Feedback Bundle and Bi-weekly audit and feedback emails in people with Quality Improvement, run by University of California, San Francisco at 1 site in United States.
Trial summary
This single-blinded, cluster randomized control trial will assess the effectiveness of an audit and feedback bundle on internal medicine physician performance on selected quality metrics. The feedback bundle includes an electronic dashboard and weekly feedback rounds in which physicians will review their performance. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Quality Improvement
- What is being tested?
- Audit and Feedback Bundle and Bi-weekly audit and feedback emails
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 200 participants
- Where
- 1 siteUnited States
- Study dates
- Feb 2016to May 2017
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- All physicians that rotate through internal medicine wards during the study period (teaching attending physicians and internal medicine residents and interns)
Who cannot join
- None
Trial locations and contacts
1 site in 1 country.
United States1 site
University of California San Francisco
San Francisco, California, 94143
About this study
Official title: The Effect of a Novel Electronic Physician Audit and Feedback Bundle on Inpatient Performance Metrics
This single-blinded, cluster randomized control trial will assess the effectiveness of an audit and feedback bundle on internal medicine physician performance on selected quality metrics. The feedback bundle includes an electronic dashboard and weekly feedback rounds in which physicians will review their performance. The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance.
Read the detailed description
This is a single-blinded, cluster randomized control trial of 48 internal medicine teams (24 teams will be randomized to the intervention arm and and 24 teams randomized to control arm) on inpatient medicine wards. Each team consists of at least 4 members (attending physician, senior resident, two interns). The intervention arm teams will receive the new audit and feedback bundle, which includes access to the electronic dashboard and weekly feedback rounds in which they review their performance on several inpatient quality metrics via the electronic dashboard. The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance on selected quality measures. This primary aim of the trial will be to compare the effectiveness of performance feedback on inpatient quality metrics specifically high quality after visit summary, medical reconciliation and discharge summary timeliness. Other group comparisons will include other inpatient quality metrics and satisfaction with feedback.
- Conditions
- Quality Improvement
- Being tested
- Audit and Feedback Bundle, Bi-weekly audit and feedback emails
- Keywords
- Quality Improvement, Quality Indicators, Health Care, Hospital Medicine
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Audit and Feedback BundleOther
The intervention arm teams will receive the new audit and feedback bundle, which includes access to the electronic dashboard and weekly feedback rounds in which they review their performance on several inpatient quality metrics via the dashboard.
Bi-weekly audit and feedback emailsOther
The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance on selected quality measures.
| Study group | Role | What they receive |
|---|---|---|
| Intervention Audit and Feedback Bundle | Experimental | Access to the electronic dashboard and weekly feedback rounds Receives: Other: Audit and Feedback Bundle |
| Bi-weekly audit and feedback emails | Active comparator | Access to biweekly feedback emails with performance on selected quality measures (current practice). Receives: Other: Bi-weekly audit and feedback emails |
What is being measured
The primary outcome is the main question the study is designed to answer.
Proportion of patients with a high quality after visit summary
The number of hospital medicine team patients with after visit summaries of high quality divided by the total number hospital medicine team patients with an after visit summary.
Measured: 6 months
Proportion of patients with discharge summary timeliness
The number of discharge summaries completed within 24 hours of discharge for hospital medicine team patients/total number of discharges from hospital medicine with a discharge summary completed
Measured: 6 months
Proportion of patients Complete Medication Reconciliation by Discharge
The total number of patients with an action taken on all home medications divided by the total number of patients on the hospital medicine teaching service.
Measured: 6 months
Proportion of patients achieving a high quality 'perfect' discharge
Proportion of patients who have a high quality after visit summary and a discharge summary completed within 24 of discharge and all medications reconciled by discharge.
Measured: 6 months
Secondary outcomes (4)
Proportion of attending and resident physicians who 'strongly agree' that they are satisfied with the audit and feedback of performance data that they receive.
Proportion of attending and resident physicians who 'strongly agree' that they are satisfied with the audit and feedback of performance data that they receive. This specific satisfaction item has been developed by the study team.
Measured: 6 months
Total Phlebotomy Sticks
The total number of unique accession numbers for each unique hospitalization of a patient
Measured: 6 months
Percent of Patients on Telemetry Until Discharge
The number of patients on without a discontinue order for telemetry within two hours of their discharge date time divided by the total number of patients on telemetry for hospital medicine teams
Measured: 6 months
Proportion of patients discharged by noon
The number of patients discharged by hospital medicine team attendings by noon (6am-11:59am)/total number of discharges by hospital medicine team attendings
Measured: 6 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Nov 2015 (estimated)
- Study startFeb 2016
- Primary completionDec 2016
- Study completionMay 2017
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Quality ImprovementStudies of the same condition, open and under way.
- More trials run by University of California, San FranciscoThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Investigator
- Enrolment
- 200 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of California, San Francisco
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Alvin R Rajkomar, MD, Principal investigator, University of California, San Francisco
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02593253
- Sponsor's protocol ID
- 15-17709
- Status last verified
- May 2017
- First submitted
- 23 Oct 2015
- Last updated
- 9 May 2017
- Results posted
- No
- Data monitoring committee
- Yes
Publications
Patel S, Rajkomar A, Harrison JD, Prasad PA, Valencia V, Ranji SR, Mourad M. Next-generation audit and feedback for inpatient quality improvement using electronic health record data: a cluster randomised controlled trial. BMJ Qual Saf. 2018 Sep;27(9):691-699. doi: 10.1136/bmjqs-2017-007393. Epub 2018 Mar 5.
PubMed 29507124
Study at a glance
From the registry record, last updated by the sponsor on 9 May 2017. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effect of a Novel Electronic Physician Audit and Feedback Bundle on Inpatient Performance Metrics
- ClinicalTrials.gov ID
- NCT02593253
- Acronym / sponsor ID
- 15-17709
- Conditions
- Quality Improvement
- Keywords
- Quality Improvement, Quality Indicators, Health Care, Hospital Medicine
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 200 participants (actual)
- Lead sponsor
- University of California, San FranciscoUniversity, hospital or other
- Study start
- Feb 2016 (actual)
- Primary completion
- Dec 2016 (actual)
- Study completion
- May 2017 (actual)
- First posted
- 2 Nov 2015 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This single-blinded, cluster randomized control trial will assess the effectiveness of an audit and feedback bundle on internal medicine physician performance on selected quality metrics. The feedback bundle includes an electronic dashboard and weekly feedback rounds in which physicians will review their performance. The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance.
Detailed description
This is a single-blinded, cluster randomized control trial of 48 internal medicine teams (24 teams will be randomized to the intervention arm and and 24 teams randomized to control arm) on inpatient medicine wards. Each team consists of at least 4 members (attending physician, senior resident, two interns). The intervention arm teams will receive the new audit and feedback bundle, which includes access to the electronic dashboard and weekly feedback rounds in which they review their performance on several inpatient quality metrics via the electronic dashboard. The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance on selected quality measures. This primary aim of the trial will be to compare the effectiveness of performance feedback on inpatient quality metrics specifically high quality after visit summary, medical reconciliation and discharge summary timeliness. Other group comparisons will include other inpatient quality metrics and satisfaction with feedback.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Intervention Audit and Feedback Bundle | Experimental | Other: Audit and Feedback BundleAccess to the electronic dashboard and weekly feedback rounds |
| Bi-weekly audit and feedback emails | Active comparator | Other: Bi-weekly audit and feedback emailsAccess to biweekly feedback emails with performance on selected quality measures (current practice). |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- All physicians that rotate through internal medicine wards during the study period (teaching attending physicians and internal medicine residents and interns)
Key exclusion criteria (1 listed)
- None
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Audit and Feedback BundleThe intervention arm teams will receive the new audit and feedback bundle, which includes access to the electronic dashboard and weekly feedback rounds in which they review their performance on several inpatient quality metrics via the dashboard. | Other | Intervention Audit and Feedback Bundle |
| Bi-weekly audit and feedback emailsThe control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance on selected quality measures. | Other | Bi-weekly audit and feedback emails |
Primary outcome
Proportion of patients with a high quality after visit summary
Time frame: 6 months
The number of hospital medicine team patients with after visit summaries of high quality divided by the total number hospital medicine team patients with an after visit summary.
Proportion of patients with discharge summary timeliness
Time frame: 6 months
The number of discharge summaries completed within 24 hours of discharge for hospital medicine team patients/total number of discharges from hospital medicine with a discharge summary completed
Proportion of patients Complete Medication Reconciliation by Discharge
Time frame: 6 months
The total number of patients with an action taken on all home medications divided by the total number of patients on the hospital medicine teaching service.
Proportion of patients achieving a high quality 'perfect' discharge
Time frame: 6 months
Proportion of patients who have a high quality after visit summary and a discharge summary completed within 24 of discharge and all medications reconciled by discharge.
4 secondary outcomes
Proportion of attending and resident physicians who 'strongly agree' that they are satisfied with the audit and feedback of performance data that they receive.
Time frame: 6 months
Total Phlebotomy Sticks
Time frame: 6 months
Percent of Patients on Telemetry Until Discharge
Time frame: 6 months
Proportion of patients discharged by noon
Time frame: 6 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 May 2017.
- Derived from this study: PubMed 29507124Patel S, Rajkomar A, Harrison JD, Prasad PA, Valencia V, Ranji SR, Mourad M. Next-generation audit and feedback for inpatient quality improvement using electronic health record data: a cluster randomised controlled trial. BMJ Qual Saf. 2018 Sep;27(9):691-699. doi: 10.1136/bmjqs-2017-007393. Epub 2018 Mar 5.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Alvin R Rajkomar, MD principal investigator
University of California, San Francisco
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Audit and Feedback Bundle and Bi-weekly audit and feedback emails in people with Quality Improvement, run by University of California, San Francisco at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 9 May 2017. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Proportion of patients with a high quality after visit summary (time frame: 6 months). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02593253, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 May 2017; AzTrials last refreshed its copy on 1 Nov 2026.