Using audit and feedback to increase clinician adherence to clinical practice guidelines in brain injury rehabilitation: A before and after study
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Date
2019-03-13
Authors
Jolliffe, Laura
Morarty, Jacqui
Hoffmann, Tammy
Crotty, Maria
Hunter, Peter
Cameron, Ian D
Li, Xia
Lannin, Natasha A
Journal Title
Journal ISSN
Volume Title
Publisher
Public LIbrary of Science
Rights
Copyright: © 2019 Jolliffe et al.
Rights Holder
Jolliffe et al.
Abstract
Objective
This study evaluated whether frequent (fortnightly) audit and feedback cycles over a sustained period of time (>12 months) increased clinician adherence to recommended guidelines in acquired brain injury rehabilitation.
Design
A before and after study design.
Setting
A metropolitan inpatient brain injury rehabilitation unit.
Participants
Clinicians; medical, nursing and allied health staff.
Interventions
Fortnightly cycles of audit and feedback for 14 months. Each fortnight, medical file and observational audits were completed against 114 clinical indicators.
Main outcome measure
Adherence to guideline indicators before and after intervention, calculated by proportions, Mann-Whitney U and Chi square analysis.
Results
Clinical and statistical significant improvements in median clinical indicator adherence were found immediately following the audit and feedback program from 38.8% (95% CI 34.3 to 44.4) to 83.6% (95% CI 81.8 to 88.5). Three months after cessation of the intervention, median adherence had decreased from 82.3% to 76.6% (95% CI 72.7 to 83.3, p<0.01). Findings suggest that there are individual indicators which are more amenable to change using an audit and feedback program.
Conclusion
A fortnightly audit and feedback program increased clinicians’ adherence to guideline recommendations in an inpatient acquired brain injury rehabilitation setting. We propose future studies build on the evidence-based method used in the present study to determine effectiveness and develop an implementation toolkit for scale-up.
Description
Copyright: © 2019 Jolliffe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords
brain injury, rehabilitation, acquired brain injury, guidelines, audit and feedback cycles
Citation
Jolliffe, L., Morarty, J., Hoffmann, T., Crotty, M., Hunter, P., Cameron, I. D., … Lannin, N. A. (2019). Using audit and feedback to increase clinician adherence to clinical practice guidelines in brain injury rehabilitation: A before and after study. PLOS ONE, 14(3), e0213525. https://doi.org/10.1371/journal.pone.0213525