Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya. Issue 4 (23rd October 2017)

• Record Type: Journal Article
• Authors: 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
• Other Names: author non-byline.; Chepkirui Mercy author non-byline.; Tuti Timothy author non-byline.; Lagat Abraham author non-byline.; N'gar Samuel author non-byline.; Muroki Ian author non-byline.; Kimutai David author non-byline.; Mutai Loice author non-byline.; Emadau Caren author non-byline.; Mutiso Cecilia author non-byline.; Nzioki Charles author non-byline.; Kanyingi Francis author non-byline.; Mithamo Agnes author non-byline.; Kuria Margaret author non-byline.; Otido Sam author non-byline.; Wachira Grace author non-byline.; Kariuki Alice author non-byline.; Njiiri Peris author non-byline.; Inginia Rachel author non-byline.; Musabi Melab author non-byline.; Odeny Hilda author non-byline.; Ochieng Grace author non-byline.; Thuranira Lydia author non-byline.; Oweso Priscilla author non-byline.; Namayi Ernest author non-byline.; Wambani Benard author non-byline.; Soita Samuel author non-byline.; Nganga Joseph author non-byline.; Waweru Margaret author non-byline.; Karanja John author non-byline.; Owano Susan author non-byline.; Muthiani Esther author non-byline.; Wanjau Alfred author non-byline.; Mwallo Larry author non-byline.; Wanjiru Lydia author non-byline.; Kinyua Consolata author non-byline.; Nguri Mary author non-byline.; Munjalu Dorothy author non-byline.;
• Is Part Of: BMJ global health. Volume 2:Issue 4(2017)
• Publication Date: 2017-10-23
• Subjects: audit and feedback -- quality improvement indicators -- performance change.; World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2017-000468
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : Background: Audit 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. Methods: We 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. Results: Data 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. Conclusion: Our 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.