Article Text
Abstract
Background The audit-feedback cycle is a behaviour change intervention used to reduce evidence-practice gaps. In this study, repeat audits, feedback, education and training were used to change practice and increase compliance with Australian guideline recommendations for stroke rehabilitation.
Objective To increase the proportion of patients with stroke receiving best practice screening, assessment and treatment.
Methods A before-and-after study design was used. Data were collected from medical records (n=15 files per audit). Four audits were conducted between 2009 and 2013. Consecutive files of patients with stroke admitted to the stroke unit were selected and audited retrospectively. Staff behaviour change interventions included four cycles of audit feedback, and education to assist staff with change. The primary outcome measure was the proportion of eligible patients receiving best practice against target behaviours, based on audit data.
Results Between the first and fourth audit (2009 and 2013), 20 of the 27 areas targeted (74%) met or exceeded the minimum target of 10% change. Practice areas that showed the most change included sensation screening (+75%) and rehabilitation (+100%); neglect screening (+92%) and assessment (100%). Some target behaviours showed a drop in compliance such as anxiety and depression screening (−27%) or little or no overall improvement such as patient education about stroke (6% change).
Conclusions Audit feedback and education increased the proportion of inpatients with stroke receiving best practice rehabilitation in some, but not all practice areas. An ongoing process of quality improvement is needed to help sustain these improvements.
- implementation science
- health services research
- audit and feedback
- evidence-based medicine
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Footnotes
Contributors AV, AM and KS did the conception, design, analysis and interpretation of data.
Funding This study was supported by an infrastructure grant from the Ingham Institute for Applied Medical Research. The funder had no role in the design, conduct, analyses or reporting of the study or in the decision to submit the manuscript for publication.
Competing interests AM was supported between 2007 and 2011 by fellowships from the National Institute of Clinical Studies - National Health and Medical Research Council, the National Stroke Foundation, the University of Sydney, Royal Rehabilitation Centre Sydney.
Ethics approval This study was approved by the SWSLHD Human Research and Ethics Committee (HRECNo. QA 2008/046).
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement Full copies of the resources, that is, audit tool, audit reports and audit presentations are available by request to angela.vratsistas@sydney.edu.au.