title: Understanding feedback report uptake: process evaluation findings from a 13-month feedback intervention in long-term care settings.
abstract: BACKGROUND
  Long-term care settings provide care to a large proportion of predominantly older, highly disabled adults across the United States and Canada. Managing and improving quality of care is challenging, in part because staffing is highly dependent on relatively non-professional health care aides and resources are limited. Feedback interventions in these settings are relatively rare, and there has been little published information about the process of feedback intervention. Our objectives were to describe the key components of uptake of the feedback reports, as well as other indicators of participant response to the intervention.
  
  
  METHODS
  We conducted this project in nine long-term care units in four facilities in Edmonton, Canada. We used mixed methods, including observations during a 13-month feedback report intervention with nine post-feedback survey cycles, to conduct a process evaluation of a feedback report intervention in these units. We included all facility-based direct care providers (staff) in the feedback report distribution and survey administration. We conducted descriptive analyses of the data from observations and surveys, presenting this in tabular and graphic form. We constructed a short scale to measure uptake of the feedback reports. Our analysis evaluated feedback report uptake by provider type over the 13 months of the intervention.
  
  
  RESULTS
  We received a total of 1,080 survey responses over the period of the intervention, which varied by type of provider, facility, and survey month. Total number of reports distributed ranged from 103 in cycle 12 to 229 in cycle 3, although the method of delivery varied widely across the period, from 12% to 65% delivered directly to individuals and 15% to 84% left for later distribution. The key elements of feedback uptake, including receiving, reading, understanding, discussing, and reporting a perception that the reports were useful, varied by survey cycle and provider type, as well as by facility. Uptake, as we measured it, was consistently high overall, but varied widely by provider type and time period.
  
  
  CONCLUSIONS
  We report detailed process data describing the aspects of uptake of a feedback report during an intensive, longitudinal feedback intervention in long-term care facilities. Uptake is a complex process for which we used multiple measures. We demonstrate the feasibility of conducting a complex longitudinal feedback intervention in relatively resource-poor long-term care facilities to a wider range of provider types than have been included in prior feedback interventions.
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. salesann@umich.edu.|Center for Clinical Management Research, VA Ann Arbor Healthcare System, Division of Nursing Business and Health Systems, School of Nursing, University of Michigan, 400 N. Ingalls Street, Ann Arbor, MI, 48109-5482, USA. salesann@umich.edu.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sales
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. kdfraser@ualberta.ca.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Fraser
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. melba.baylon@ualberta.ca.
authors.forename: Melba Andrea B
authors.initials: MA
authors.lastname: Baylon
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. hannah.orourke@ualberta.ca.
authors.forename: Hannah M
authors.initials: HM
authors.lastname: O'Rourke
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. gloria.gao@ualberta.ca.
authors.forename: Gloria
authors.initials: G
authors.lastname: Gao
authors.affiliation: Faculty of Nursing, Deakin University, Melbourne, VIC, Australia. tracey.bucknall@deakin.edu.au.
authors.forename: Tracey
authors.initials: T
authors.lastname: Bucknall
authors.affiliation: Shepherd's Care Foundation, Edmonton, AB, Canada. smaisey@shepherdshealth.org.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Maisey
mesh_terms: D005246:Feedback; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration / Q000592:standards*; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards; D011795:Surveys and Questionnaires