Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya
BackgroundAudit and feedback (A&F) is widely used in healthcare but there are few examples of how to deploy it at scale in low-income countries. Establishing the Clinical Information Network (CIN) in Kenya provided an opportunity to examine the effect of A&F delivered as part of a wider set...
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| Veröffentlicht in: | BMJ global health 2017-12, Vol.2 (4), p.e000468-e000468 |
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| creator | Gachau, Susan Ayieko, Philip Gathara, David Mwaniki, Paul Ogero, Morris Akech, Samuel Maina, Michuki Agweyu, Ambrose Oliwa, Jacquie Julius, Thomas Malla, Lucas Wafula, James Mbevi, George Irimu, Grace English, Mike |
| description | BackgroundAudit and feedback (A&F) is widely used in healthcare but there are few examples of how to deploy it at scale in low-income countries. Establishing the Clinical Information Network (CIN) in Kenya provided an opportunity to examine the effect of A&F delivered as part of a wider set of activities to promote paediatric guideline adherence.MethodsWe analysed data collected from medical records on discharge for children aged 2–59 months from 14 Kenyan hospitals in the CIN. Hospitals joined CIN in phases and for each we analysed their initial 25 months of participation that occurred between December 2013 and March 2016. A total of 34 indicators of adherence to recommendations were selected for evaluation each classified by form of feedback (passive, active and none) and type of task (simple or difficult documentation and those requiring cognitive work). Performance change was explored graphically and using generalised linear mixed models with attention given to the effects of time and use of a standardised paediatric admission record (PAR) form.ResultsData from 60 214 admissions were eligible for analysis. Adherence to recommendations across hospitals significantly improved for 24/34 indicators. Improvements were not obviously related to nature of feedback, may be related to task type and were related to PAR use in the case of documentation indicators. There was, however, marked variability in adoption and adherence to recommended practices across sites and indicators. Hospital-specific factors, low baseline performance and specific contextual changes appeared to influence the magnitude of change in specific cases.ConclusionOur observational data suggest some change in multiple indicators of adherence to recommendations (aspects of quality of care) can be achieved in low-resource hospitals using A&F and simple job aides in the context of a wider network approach. |
| doi_str_mv | 10.1136/bmjgh-2017-000468 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5663259</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2551752526</sourcerecordid><originalsourceid>FETCH-LOGICAL-b464t-1cff06afb623be059815b960a66f72fe2343ed246b5dde8a68cad68a87ad89c73</originalsourceid><addsrcrecordid>eNqNks9u1DAQxiMEolXpA3BBlrhwIGA7sZNcQKiUP6ISFzhbE3uc9ZLYwU4W7dv0UetlS1U4cbE9nt989thfUTxl9BVjlXzdT9thU3LKmpJSWsv2QXHKqejKpqPtw3vrk-I8pW1mWJMHKh8XJ7xjtG5kd1pcvw-YCKzGLQS8IRbR9KB_EDfNMeyQLBskYMK8uOBJsCSiDtOE3qAhcwS9OI3pLbncOYNeI7ExTATIGPzglizrYSShTxh3cJDIUcrb-4MUeIITxsH5gejReadz1uPyK8R8vidf0O_hSfHIwpjw_HY-K75_uPx28am8-vrx88W7q7KvZb2UTFtLJdhe8qrH3HrLRN9JClLahlvkVV2h4bXshTHYgmw1GNlC24BpO91UZ8Wbo-689hMajX6JMKo5ugniXgVw6u-Mdxs1hJ0SUlZcdFngxa1ADD9XTIuaXNI4juAxrEmxTjJaVaJlGX3-D7oNa8xvkxQXgjWCCy4zxY6UjiGliPbuMoyqgwXUbwuogwXU0QK55tn9Lu4q_nx4Bl4egVz7H3o3dYe_iw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2551752526</pqid></control><display><type>article</type><title>Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya</title><source>BMJ Open Access Journals</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>PubMed Central Open Access</source><creator>Gachau, Susan ; Ayieko, Philip ; Gathara, David ; Mwaniki, Paul ; Ogero, Morris ; Akech, Samuel ; Maina, Michuki ; Agweyu, Ambrose ; Oliwa, Jacquie ; Julius, Thomas ; Malla, Lucas ; Wafula, James ; Mbevi, George ; Irimu, Grace ; English, Mike</creator><creatorcontrib>Gachau, Susan ; Ayieko, Philip ; Gathara, David ; Mwaniki, Paul ; Ogero, Morris ; Akech, Samuel ; Maina, Michuki ; Agweyu, Ambrose ; Oliwa, Jacquie ; Julius, Thomas ; Malla, Lucas ; Wafula, James ; Mbevi, George ; Irimu, Grace ; English, Mike</creatorcontrib><description>BackgroundAudit and feedback (A&F) is widely used in healthcare but there are few examples of how to deploy it at scale in low-income countries. Establishing the Clinical Information Network (CIN) in Kenya provided an opportunity to examine the effect of A&F delivered as part of a wider set of activities to promote paediatric guideline adherence.MethodsWe analysed data collected from medical records on discharge for children aged 2–59 months from 14 Kenyan hospitals in the CIN. Hospitals joined CIN in phases and for each we analysed their initial 25 months of participation that occurred between December 2013 and March 2016. A total of 34 indicators of adherence to recommendations were selected for evaluation each classified by form of feedback (passive, active and none) and type of task (simple or difficult documentation and those requiring cognitive work). Performance change was explored graphically and using generalised linear mixed models with attention given to the effects of time and use of a standardised paediatric admission record (PAR) form.ResultsData from 60 214 admissions were eligible for analysis. Adherence to recommendations across hospitals significantly improved for 24/34 indicators. Improvements were not obviously related to nature of feedback, may be related to task type and were related to PAR use in the case of documentation indicators. There was, however, marked variability in adoption and adherence to recommended practices across sites and indicators. Hospital-specific factors, low baseline performance and specific contextual changes appeared to influence the magnitude of change in specific cases.ConclusionOur observational data suggest some change in multiple indicators of adherence to recommendations (aspects of quality of care) can be achieved in low-resource hospitals using A&F and simple job aides in the context of a wider network approach.</description><identifier>ISSN: 2059-7908</identifier><identifier>EISSN: 2059-7908</identifier><identifier>DOI: 10.1136/bmjgh-2017-000468</identifier><identifier>PMID: 29104769</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Audits ; Data collection ; Documentation ; Feedback ; Global health ; Hospitals ; Intervention ; Low income areas ; Low income groups ; Malaria ; Meetings ; Observational studies ; Pediatrics ; Quality control ; Quality improvement ; Teams</subject><ispartof>BMJ global health, 2017-12, Vol.2 (4), p.e000468-e000468</ispartof><rights>Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><rights>2017 Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b464t-1cff06afb623be059815b960a66f72fe2343ed246b5dde8a68cad68a87ad89c73</citedby><cites>FETCH-LOGICAL-b464t-1cff06afb623be059815b960a66f72fe2343ed246b5dde8a68cad68a87ad89c73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://gh.bmj.com/content/2/4/e000468.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://gh.bmj.com/content/2/4/e000468.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27526,27527,27901,27902,53766,53768,77344,77375</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29104769$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gachau, Susan</creatorcontrib><creatorcontrib>Ayieko, Philip</creatorcontrib><creatorcontrib>Gathara, David</creatorcontrib><creatorcontrib>Mwaniki, Paul</creatorcontrib><creatorcontrib>Ogero, Morris</creatorcontrib><creatorcontrib>Akech, Samuel</creatorcontrib><creatorcontrib>Maina, Michuki</creatorcontrib><creatorcontrib>Agweyu, Ambrose</creatorcontrib><creatorcontrib>Oliwa, Jacquie</creatorcontrib><creatorcontrib>Julius, Thomas</creatorcontrib><creatorcontrib>Malla, Lucas</creatorcontrib><creatorcontrib>Wafula, James</creatorcontrib><creatorcontrib>Mbevi, George</creatorcontrib><creatorcontrib>Irimu, Grace</creatorcontrib><creatorcontrib>English, Mike</creatorcontrib><title>Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya</title><title>BMJ global health</title><addtitle>BMJ Glob Health</addtitle><description>BackgroundAudit and feedback (A&F) is widely used in healthcare but there are few examples of how to deploy it at scale in low-income countries. Establishing the Clinical Information Network (CIN) in Kenya provided an opportunity to examine the effect of A&F delivered as part of a wider set of activities to promote paediatric guideline adherence.MethodsWe analysed data collected from medical records on discharge for children aged 2–59 months from 14 Kenyan hospitals in the CIN. Hospitals joined CIN in phases and for each we analysed their initial 25 months of participation that occurred between December 2013 and March 2016. A total of 34 indicators of adherence to recommendations were selected for evaluation each classified by form of feedback (passive, active and none) and type of task (simple or difficult documentation and those requiring cognitive work). Performance change was explored graphically and using generalised linear mixed models with attention given to the effects of time and use of a standardised paediatric admission record (PAR) form.ResultsData from 60 214 admissions were eligible for analysis. Adherence to recommendations across hospitals significantly improved for 24/34 indicators. Improvements were not obviously related to nature of feedback, may be related to task type and were related to PAR use in the case of documentation indicators. There was, however, marked variability in adoption and adherence to recommended practices across sites and indicators. Hospital-specific factors, low baseline performance and specific contextual changes appeared to influence the magnitude of change in specific cases.ConclusionOur observational data suggest some change in multiple indicators of adherence to recommendations (aspects of quality of care) can be achieved in low-resource hospitals using A&F and simple job aides in the context of a wider network approach.</description><subject>Audits</subject><subject>Data collection</subject><subject>Documentation</subject><subject>Feedback</subject><subject>Global health</subject><subject>Hospitals</subject><subject>Intervention</subject><subject>Low income areas</subject><subject>Low income groups</subject><subject>Malaria</subject><subject>Meetings</subject><subject>Observational studies</subject><subject>Pediatrics</subject><subject>Quality control</subject><subject>Quality improvement</subject><subject>Teams</subject><issn>2059-7908</issn><issn>2059-7908</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>BENPR</sourceid><recordid>eNqNks9u1DAQxiMEolXpA3BBlrhwIGA7sZNcQKiUP6ISFzhbE3uc9ZLYwU4W7dv0UetlS1U4cbE9nt989thfUTxl9BVjlXzdT9thU3LKmpJSWsv2QXHKqejKpqPtw3vrk-I8pW1mWJMHKh8XJ7xjtG5kd1pcvw-YCKzGLQS8IRbR9KB_EDfNMeyQLBskYMK8uOBJsCSiDtOE3qAhcwS9OI3pLbncOYNeI7ExTATIGPzglizrYSShTxh3cJDIUcrb-4MUeIITxsH5gejReadz1uPyK8R8vidf0O_hSfHIwpjw_HY-K75_uPx28am8-vrx88W7q7KvZb2UTFtLJdhe8qrH3HrLRN9JClLahlvkVV2h4bXshTHYgmw1GNlC24BpO91UZ8Wbo-689hMajX6JMKo5ugniXgVw6u-Mdxs1hJ0SUlZcdFngxa1ADD9XTIuaXNI4juAxrEmxTjJaVaJlGX3-D7oNa8xvkxQXgjWCCy4zxY6UjiGliPbuMoyqgwXUbwuogwXU0QK55tn9Lu4q_nx4Bl4egVz7H3o3dYe_iw</recordid><startdate>20171201</startdate><enddate>20171201</enddate><creator>Gachau, Susan</creator><creator>Ayieko, Philip</creator><creator>Gathara, David</creator><creator>Mwaniki, Paul</creator><creator>Ogero, Morris</creator><creator>Akech, Samuel</creator><creator>Maina, Michuki</creator><creator>Agweyu, Ambrose</creator><creator>Oliwa, Jacquie</creator><creator>Julius, Thomas</creator><creator>Malla, Lucas</creator><creator>Wafula, James</creator><creator>Mbevi, George</creator><creator>Irimu, Grace</creator><creator>English, Mike</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20171201</creationdate><title>Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya</title><author>Gachau, Susan ; Ayieko, Philip ; Gathara, David ; Mwaniki, Paul ; Ogero, Morris ; Akech, Samuel ; Maina, Michuki ; Agweyu, Ambrose ; Oliwa, Jacquie ; Julius, Thomas ; Malla, Lucas ; Wafula, James ; Mbevi, George ; Irimu, Grace ; English, Mike</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b464t-1cff06afb623be059815b960a66f72fe2343ed246b5dde8a68cad68a87ad89c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Audits</topic><topic>Data collection</topic><topic>Documentation</topic><topic>Feedback</topic><topic>Global health</topic><topic>Hospitals</topic><topic>Intervention</topic><topic>Low income areas</topic><topic>Low income groups</topic><topic>Malaria</topic><topic>Meetings</topic><topic>Observational studies</topic><topic>Pediatrics</topic><topic>Quality control</topic><topic>Quality improvement</topic><topic>Teams</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gachau, Susan</creatorcontrib><creatorcontrib>Ayieko, Philip</creatorcontrib><creatorcontrib>Gathara, David</creatorcontrib><creatorcontrib>Mwaniki, Paul</creatorcontrib><creatorcontrib>Ogero, Morris</creatorcontrib><creatorcontrib>Akech, Samuel</creatorcontrib><creatorcontrib>Maina, Michuki</creatorcontrib><creatorcontrib>Agweyu, Ambrose</creatorcontrib><creatorcontrib>Oliwa, Jacquie</creatorcontrib><creatorcontrib>Julius, Thomas</creatorcontrib><creatorcontrib>Malla, Lucas</creatorcontrib><creatorcontrib>Wafula, James</creatorcontrib><creatorcontrib>Mbevi, George</creatorcontrib><creatorcontrib>Irimu, Grace</creatorcontrib><creatorcontrib>English, Mike</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ global health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gachau, Susan</au><au>Ayieko, Philip</au><au>Gathara, David</au><au>Mwaniki, Paul</au><au>Ogero, Morris</au><au>Akech, Samuel</au><au>Maina, Michuki</au><au>Agweyu, Ambrose</au><au>Oliwa, Jacquie</au><au>Julius, Thomas</au><au>Malla, Lucas</au><au>Wafula, James</au><au>Mbevi, George</au><au>Irimu, Grace</au><au>English, Mike</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya</atitle><jtitle>BMJ global health</jtitle><addtitle>BMJ Glob Health</addtitle><date>2017-12-01</date><risdate>2017</risdate><volume>2</volume><issue>4</issue><spage>e000468</spage><epage>e000468</epage><pages>e000468-e000468</pages><issn>2059-7908</issn><eissn>2059-7908</eissn><abstract>BackgroundAudit and feedback (A&F) is widely used in healthcare but there are few examples of how to deploy it at scale in low-income countries. Establishing the Clinical Information Network (CIN) in Kenya provided an opportunity to examine the effect of A&F delivered as part of a wider set of activities to promote paediatric guideline adherence.MethodsWe analysed data collected from medical records on discharge for children aged 2–59 months from 14 Kenyan hospitals in the CIN. Hospitals joined CIN in phases and for each we analysed their initial 25 months of participation that occurred between December 2013 and March 2016. A total of 34 indicators of adherence to recommendations were selected for evaluation each classified by form of feedback (passive, active and none) and type of task (simple or difficult documentation and those requiring cognitive work). Performance change was explored graphically and using generalised linear mixed models with attention given to the effects of time and use of a standardised paediatric admission record (PAR) form.ResultsData from 60 214 admissions were eligible for analysis. Adherence to recommendations across hospitals significantly improved for 24/34 indicators. Improvements were not obviously related to nature of feedback, may be related to task type and were related to PAR use in the case of documentation indicators. There was, however, marked variability in adoption and adherence to recommended practices across sites and indicators. Hospital-specific factors, low baseline performance and specific contextual changes appeared to influence the magnitude of change in specific cases.ConclusionOur observational data suggest some change in multiple indicators of adherence to recommendations (aspects of quality of care) can be achieved in low-resource hospitals using A&F and simple job aides in the context of a wider network approach.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>29104769</pmid><doi>10.1136/bmjgh-2017-000468</doi><oa>free_for_read</oa></addata></record> |
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| source | BMJ Open Access Journals; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access |
| subjects | Audits Data collection Documentation Feedback Global health Hospitals Intervention Low income areas Low income groups Malaria Meetings Observational studies Pediatrics Quality control Quality improvement Teams |
| title | Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya |
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