Cluster randomized controlled trial of the effectiveness of audit and feedback and educational outreach on improving nursing practice and patient outcomes.
BACKGROUND
Current understanding of implementation methods is limited, and research has focused on changing doctors' behaviors.


OBJECTIVE
Our aim was to evaluate the impact of audit and feedback and educational outreach in improving nursing practice and patient outcomes.


METHODS
Using a factorial design, cluster randomized controlled trial, we evaluated 194 community nurses in 157 family practices and 1078 patients with diagnosis of urinary incontinence (UI) for nurses compliance with evidence-linked review criteria for the assessment and management of UI and impact on psychologic and social well-being and symptoms. In the outreach arms, nurses' self-reported barriers informed development of tailored strategies.


RESULTS
In comparison with educational materials alone, the implementation methods tested did not improve care at 6 months follow-up. Moderate rates of improvement (10-17% of patients) in performance for the assessment of UI and greater rates of improvement (20-30% of patients) for the management of care were found but effects were similar across arms. Improvement in patient outcomes was more consistently positive for educational outreach than for audit and feedback but differences were not significant. Adjustment for caseload size, severity or duration of UI and patients' age did not alter results.


CONCLUSIONS
Printed educational materials alone may be as effective as audit and feedback and educational outreach in improving nurses' performance and outcomes of care for people with UI. Greater understanding of the underlying processes in improving performance within multidisciplinary teams through further, theory-driven studies with "no intervention" control groups and longer follow-up are needed.
Cheater
Francine M
FM
School of Healthcare, University of Leeds, Leeds, and Leicestershire & Rutland Healthcare NHS Trust, Gorse Hill Hospital, Leicester, United Kingdom. f.m.cheater@leeds.ac.uk
Baker
Richard
R
Reddish
Stuart
S
Spiers
Nicola
N
Wailoo
Allan
A
Gillies
Clare
C
Robertson
Noelle
N
Cawood
Catherine
C
D004509:Education, Nursing, Continuing; D005163:Factor Analysis, Statistical; D005194:Family Practice; D005246:Feedback; D019983:Guideline Adherence; D006801:Humans; D009731:Nursing Audit; D009732:Nursing Care / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration; D014549:Urinary Incontinence / Q000451:nursing; D016526:Workload