Effect of a Multifaceted Performance Feedback Strategy on Length of Stay Compared With Benchmark Reports Alone: A Cluster Randomized Trial in Intensive Care


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Abstract

Objective:To assess the impact of applying a multifaceted activating performance feedback strategy on intensive care patient outcomes compared with passively receiving benchmark reports.Design:The Information Feedback on Quality Indicators study was a cluster randomized trial, running from February 2009 to May 2011.Setting:Thirty Dutch closed-format ICUs that participated in the national registry. Study duration per ICU was sixteen months.Patients:We analyzed data on 25,552 admissions. Admissions after coronary artery bypass graft surgery were excluded.Intervention:The intervention aimed to activate ICUs to undertake quality improvement initiatives by formalizing local responsibility for acting on performance feedback, and supporting them with increasing the impact of their improvement efforts. Therefore, intervention ICUs established a local, multidisciplinary quality improvement team. During one year, this team received two educational outreach visits, monthly reports to monitor performance over time, and extended, quarterly benchmark reports. Control ICUs only received four standard quarterly benchmark reports.Measurements and Results:The extent to which the intervention was implemented in daily practice varied considerably among intervention ICUs: the average monthly time investment per quality improvement team member was 4.1 hours (SD,2.; range, 0.6–8.1); the average number of monthly meetings per quality improvement team was 5.7 (SD, 4.5; range, 0–12). ICU length of stay did not reduce significantly after 1 year in intervention units compared with controls (hazard ratio, 1.02 [95% CI, 0.92–1.12]). Furthermore, the strategy had no statistically significant impact on any of the secondary measures (duration of mechanical ventilation, proportion of out-of-range glucose measurements, and all-cause hospital mortality).Conclusions:In the context of ICUs participating in a national registry, applying a multifaceted activating performance feedback strategy did not lead to better patient outcomes than only receiving periodical registry reports.

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