title: A mixed methods evaluation of the maternal-newborn dashboard in Ontario: dashboard attributes, contextual factors, and facilitators and barriers to use: a study protocol.
abstract: BACKGROUND
  There are wide variations in maternal-newborn care practices and outcomes across Ontario. To help institutions and care providers learn about their own performance, the Better Outcomes Registry & Network (BORN) Ontario has implemented an audit and feedback system, the Maternal-Newborn Dashboard (MND), for all hospitals providing maternal-newborn care. The dashboard provides (1) near real-time feedback, with site-specific and peer comparison data about six key performance indicators; (2) a visual display of evidence-practice gaps related to the indicators; and (3) benchmarks to provide direction for practice change. This study aims to evaluate the effects of the dashboard, dashboard attributes, contextual factors, and facilitation/support needs that influence the use of this audit and feedback system to improve performance. The objectives of this study are to (1) evaluate the effect of implementing the dashboard across Ontario; (2) explore factors that potentially explain differences in the use of the MND among hospitals; (3) measure factors potentially associated with differential effectiveness of the MND; and (4) identify factors that predict differences in hospital performance.
  
  
  METHODS
  A mixed methods design includes (1) an interrupted time series analysis to evaluate the effect of the intervention on six indicators, (2) key informant interviews with a purposeful sample of directors/managers from up to 20 maternal-newborn care hospitals to explore factors that influence the use of the dashboard, (3) a provincial survey of obstetrical directors/managers from all maternal-newborn hospitals in the province to measure factors that influence the use of the dashboard, and (4) a multivariable generalized linear mixed effects regression analysis of the indicators at each hospital to quantitatively evaluate the change in practice following implementation of the dashboard and to identify factors most predictive of use.
  
  
  CONCLUSIONS
  Study results will provide essential data to develop knowledge translation strategies for facilitating practice change, which can be further evaluated through a future cluster randomized trial.
authors.affiliation: Better Outcomes Registry & Network (BORN Ontario), Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8 L1, Canada. sdunn@bornontario.ca.
authors.forename: Sandra
authors.initials: S
authors.lastname: Dunn
authors.affiliation: Better Outcomes Registry & Network (BORN Ontario), Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8 L1, Canada.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Sprague
authors.affiliation: Department of Medicine, Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8 L6, Canada.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.affiliation: Ottawa Hospital Research Institute (OHRI), School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8 L6, Canada.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.affiliation: Ottawa Hospital Research Institute (OHRI), School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: Better Outcomes Registry & Network (BORN Ontario), 401 Smyth Road, Ottawa, ON, K1H 8 L1, Canada.
authors.forename: Deshayne
authors.initials: D
authors.lastname: Fell
authors.affiliation: School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada.
authors.forename: Wendy E
authors.initials: WE
authors.lastname: Peterson
authors.affiliation: Laurentian University, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Darling
authors.affiliation: Children's Hospital of Eastern Ontario (CHEO), 401 Smyth Road, Ottawa, ON, K1H 8 L1, Canada.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Harrold
authors.affiliation: Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2 V7, Canada.
authors.forename: Graeme N
authors.initials: GN
authors.lastname: Smith
authors.affiliation: Better Outcomes Registry & Network (BORN Ontario), Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8 L1, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Reszel
authors.affiliation: Better Outcomes Registry & Network (BORN Ontario), 401 Smyth Road, Ottawa, ON, K1H 8 L1, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lanes
authors.affiliation: Better Outcomes Registry & Network (BORN Ontario), School of Nursing, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8 L1, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Truskoski
authors.affiliation: Better Outcomes Registry & Network (BORN Ontario), 401 Smyth Road, Ottawa, ON, K1H 8 L1, Canada.
authors.forename: Jodi
authors.initials: J
authors.lastname: Wilding
authors.affiliation: Better Outcomes Registry & Network (BORN Ontario), 401 Smyth Road, Ottawa, ON, K1H 8 L1, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Weiss
authors.affiliation: Ottawa Hospital Research Institute (OHRI), University of Ottawa, Better Outcomes Registry & Network (BORN Ontario), 501 Smyth Road, Ottawa, ON, K1H 8 L6, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Walker
mesh_terms: D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D000068101:Maternal-Child Health Services; D009864:Ontario; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D012042:Registries; D012107:Research Design
keywords: Audit and feedback; Benchmarking; Dashboard; Health-care quality assurance; Knowledge translation; Maternal health services; Maternal-newborn care; Mixed methods