Unregulated provider perceptions of audit and feedback reports in long-term care: cross-sectional survey findings from a quality improvement intervention

BMC Geriatrics

Anne E Sales¹  Anne-Marie Boström²  Melba Andrea B Baylon³  Hannah M O’Rourke³  Kimberly D Fraser³ 

[1] School of Nursing, University of Michigan, Ann Arbor, MI, USA;Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden;Faculty of Nursing, University of Alberta, Edmonton, AB, Canada

关键词: Audit and feedback;    Quality of care;    Unregulated care provider;    Long-term care;   

Others  :  857894
DOI  :  10.1186/1471-2318-13-15

 received in 2012-07-02, accepted in 2013-02-04,  发布年份 2013

【 摘 要 】

Background

Audit with feedback is a moderately effective approach for improving professional practice in other health care settings. Although unregulated caregivers give the majority of direct care in long-term care settings, little is known about how they understand and perceive feedback reports because unregulated providers have not been directly targeted to receive audit with feedback in quality improvement interventions in long-term care. The purpose of this paper is to describe unregulated care providers’ perceptions of usefulness of a feedback report in four Canadian long-term care facilities.

Methods

We delivered monthly feedback reports to unregulated care providers for 13 months in 2009–2010. The feedback reports described a unit’s performance in relation to falls, depression, and pain as compared to eight other units in the study. Follow-up surveys captured participant perceptions of the feedback report. We conducted descriptive analyses of the variables related to participant perceptions and multivariable logistic regression to assess the association between perceived usefulness of the feedback report and a set of independent variables.

Results

The vast majority (80%) of unregulated care providers (n = 171) who responded said they understood the reports. Those who discussed the report with others and were interested in other forms of data were more likely to find the feedback report useful for making changes in resident care.

Conclusions

This work suggests that unregulated care providers can understand and feel positively about using audit with feedback reports to make changes to resident care. Further research should explore ways to promote fuller engagement of unregulated care providers in decision-making to improve quality of care in long-term care settings.

【 授权许可】

   
2013 Fraser et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Berta W, Laporte A, Zarnett D, Valdmanis V, Anderson G: A pan-Canadian perspective on institutional long-term care. Health Policy 2006, 79:179-194.
• [2]Rantz MJ, Hicks L, Grando V, Petroski GF, Madsen RW, Mehr DR, Conn V, Zwygart-Staffacher M, Scott J, Flesner M, Bostick J, Porter R, Maas M: Nursing home quality, cost, staffing, and staff mix. Gerontologist 2004, 44:24-38.
• [3]Alberta Health and Wellness: Continuing care health service standards. 2008. http://www.health.alberta.ca/documents/Continuing-Care-Standards-2008.pdf webcite
• [4]Alberta Health and Wellness: Health workforce action plan: addressing Alberta’s health workforce shortages. 2007. http://www.health.alberta.ca/documents/Workforce-Action Plan-2007.pdf webcite
• [5]Cohen-Mansfield J, Jensen B: Physicians’ perceptions of care in the nursing home and of strategies for improvement in a survey on treatment of behavior problems. J Am Med Dir Assoc 2008, 9:633-640.
• [6]Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD: Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2006, 2:CD000259.
• [7]Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’Brien MA, Johansen M, Grimshaw J, Oxman AD: Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012, 6:CD000259.
• [8]Alberta Office of the Auditor General: Report of the Auditor General on seniors care and programs. 2005. http://www.oag.ab.ca/files/oag/OAG_Seniors_2005.pdf webcite
• [9]Canadian Institute for Health Information: Health Care in Canada 2011: A focus on seniors and aging. 2011. https://secure.cihi.ca/free_products/HCIC_2011_seniors_report_en.pdf webcite
• [10]Alberta Health and Wellness: Continuing care strategy: aging in the right place. 2008. http://www.health.alberta.ca/documents/Continuing-Care-Strategy-2008.pdf webcite
• [11]Statistics Canada: Population by year, by province, and territory. 2010. http://www40.statcan.gc.ca/l01/cst01/demo02a-eng.htm webcite
• [12]Statistics Canada: Residential care facilities 2009/2010. 2011. http://www.statcan.gc.ca/pub/83-237-x/83-237-x2012001-eng.pdf webcite
• [13]Hirdes JP: Long-term care funding in Canada: a policy mosaic. J Aging Soc Policy 2001, 13:69-81.
• [14]Caspar S, O’Rourke N: The influence of care provider access to structural empowerment on individualized care in long-term-care facilities. J Gerontol B Psychol Sci Soc Sci 2008, 63:S255-S265.
• [15]Alberta Office of the Auditor General: Report of the Auditor General of Alberta. 2008. http://www.oag.ab.ca/files/oag/Oct_2008_Report.pdf webcite. Accessed June/29, 2012
• [16]Blair CE, Glaister JA: Making the most of nursing homes’ number one resource. Health Care Manage Rev 2005, 30:110-115.
• [17]McGilton KS, Hall LM, Wodchis WP, Petroz U: Supervisory support, job stress, and job satisfaction among long-term care nursing staff. J Nurs Adm 2007, 37:366-372.
• [18]Cruttenden KE: Long-term care planning study: strengths and learning needs of nursing staff. Can J Aging 2006, 25:347-361.
• [19]Nursing Education Program Approval Board: Standards for Alberta nursing education program leading to initial entry to practice as a Registered Nurse. 2005. http://www.nurses.ab.ca/Carna-Admin/Uploads/NEPAB%20standards.pdf webcite
• [20]Alberta Health and Wellness: Health care aides competency profile. 2001. http://www.health.alberta.ca/documents/HC-Aides-Competency-2001.pdf webcite
• [21]Glouberman S, Richards J, El Bestawi M, Seidman-Carlson R, Teperman L: Reconnecting to care: a nursing initiative at the Baycrest Geriatric Health System. Nurs Leadersh 2007, 20:39-49.
• [22]Mechanic D, Reinhard SC: Contributions of nurses to health policy: challenges and opportunities. Nurs Health Policy Rev 2002, 1:7-15.
• [23]McGillis Hall L, McGilton KS, Krejci J, Pringle D, Johnston E, Fairley L, Brown M: Enhancing the quality of supportive supervisory behavior in long-term care facilities. J Nurs Adm 2005, 35:181-187.
• [24]Kane RA: Ethics and the frontline care worker: mapping the subject. Generations 1994, 18:71-74.
• [25]Kalisch BJ, Curley M, Stefanov S: An intervention to enhance nursing staff teamwork and engagement. J Nurs Adm 2007, 37:77-84.
• [26]Yeatts DE, Cready C, Ray B, DeWitt A, Queen C: Self-managed work teams in nursing homes: implementing and empowering nurse aide teams. Gerontologist 2004, 44:256-261.
• [27]Bishop CE, Squillace MR, Meagher J, Anderson WL, Wiener JM: Nursing home work practices and nursing assistants’ job satisfaction. Gerontologist 2009, 49:611-622.
• [28]Zweig S, Lawhorne L: Improving the quality of nurse assistants in nursing homes: report of an attending physician survey and an AMDA symposium. J Am Med Dir Assoc 2001, 2:141-145.
• [29]Vogelsmeier A, Scott-Cawiezell J: Achieving quality improvement in the nursing home: influence of nursing leadership on communication and teamwork. J Nurs Care Qual 2011, 26:236-242.
• [30]Kirchner JE, Parker LE, Bonner LM, Fickel JJ, Yano EM, Ritchie MJ: Roles of managers, frontline staff and local champions, in implementing quality improvement: stakeholders’ perspectives. J Eval Clin Pract 2012, 18:63-69.
• [31]Horn SD, Sharkey SS, Hudak S, Gassaway J, James R, Spector W: Pressure ulcer prevention in long-term-care facilities: a pilot study implementing standardized nurse aide documentation and feedback reports. Adv Skin Wound Care 2010, 23:120-131.
• [32]Bonner A, MacCulloch P, Gardner T, Chase CW: A student-led demonstration project on fall prevention in a long-term care facility. Geriatr Nurs 2007, 28:312-318.
• [33]Curry C, Middleton H, Brown B: Palliative care training. Nurs Older People 2009, 21:18-23.
• [34]Gardner B, Whittington C, McAteer J, Eccles MP, Michie S: Using theory to synthesise evidence from behaviour change interventions: the example of audit and feedback. Soc Sci Med 2010, 70:1618-1625.
• [35]Rantz MJ, Popejoy L, Petroski GF, Madsen RW, Mehr DR, Zwygart-Stauffacher M, Hickes LL, Grando V, Wipke-Tevis DD, Bostick J, Porter R, Conn VS, Maas M: Randomized clinical trial of a quality improvement intervention in nursing homes. Gerontologist 2001, 41:525-538.
• [36]Morris JN, Hawes C, Fries BE, Phillips CD, Mor V, Katz S, Murphy K, Drugovich ML, Friedlob AS: Designing the national resident assessment instrument for nursing homes. Gerontologist 1990, 30:293-307.
• [37]Centres for Medicare and Medicaid Services: MDS 2.0 for nursing homes RAI users manual: Resident Assessment Instrument. 2002. http://www.cms.hhs.gov/nursinghomequalityinits/20_NHQIMDS20.asp webcite
• [38]Sales AE, Schalm C: Data for improvement and clinical excellence: protocol for an audit with feedback intervention in long term care. Implement Sci 2010, 5:74. BioMed Central Full Text
• [39]Brannon SD, Kemper P, Heier-Leitzell B, Stott A: Reinventing management practices in long-term care: how cultural evolution can affect workforce recruitment and retention. Generations 2010, 34:68-74.
• [40]Kuo HT, Yin TJ, Li IC: Relationship between organizational empowerment and job satisfaction perceived by nursing assistants at long-term care facilities. J Clin Nurs 2008, 17:3059-3066.
• [41]Mechanic D: Sources of power of lower participants in complex organizations. Adm Sci Q 1962, 7:349-364.