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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention Audit and Feedback Bundle | Experimental | Access to the electronic dashboard and weekly feedback rounds |
|
| Bi-weekly audit and feedback emails | Active Comparator | Access to biweekly feedback emails with performance on selected quality measures (current practice). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Audit and Feedback Bundle | Other | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 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 | 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. | 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. | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 6 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Alvin R Rajkomar, MD | University of California, San Francisco | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California San Francisco | San Francisco | California | 94143 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29507124 | Derived | 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. |
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| Bi-weekly audit and feedback emails | Other | The control arm will undergo audit and feedback per the current system, which is biweekly feedback emails with performance on selected quality measures. |
|
| Total Phlebotomy Sticks | The total number of unique accession numbers for each unique hospitalization of a patient | 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 | 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 | 6 months |