title: Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial.
abstract: Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units.
  
  
  
  INFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides - non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides' quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument - Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention.
  
  
  
  INFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes.
  
  
  
  ClinicalTrials.gov Identifier: NCT02695836 . Date of registration: 24 February 2016.
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. mhoben@ualberta.ca.|Alberta Innovates-Health Solutions (AIHS) post-doctoral fellow, Translating Research in Elder Care (TREC), Faculty of Nursing, University of Alberta, 5-006 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB T6G 1C9, Canada. mhoben@ualberta.ca.
authors.forename: Matthias
authors.identifier: 0000-0003-3465-315X
authors.initials: M
authors.lastname: Hoben
authors.affiliation: Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Norton
authors.affiliation: Faculty of Health, York University, School of Health Policy and Management, Toronto, Ontario, Canada.
authors.forename: Liane R
authors.initials: LR
authors.lastname: Ginsburg
authors.affiliation: School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Anderson
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Greta G
authors.initials: GG
authors.lastname: Cummings
authors.affiliation: Department of Medicine and Department of Family and Community Medicine, University of Texas, Health Science Center San Antonio, San Antonio, Texas, USA.
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Lanham
authors.affiliation: School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Squires
authors.affiliation: Interior Health Authority, Kelowna, British Columbia, Canada.
authors.forename: Deanne
authors.initials: D
authors.lastname: Taylor
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Division of Geriatric Medicine, Edmonton, Alberta, Canada.
authors.forename: Adrian S
authors.initials: AS
authors.lastname: Wagg
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Carole A
authors.initials: CA
authors.lastname: Estabrooks
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D005246:Feedback; D006801:Humans; D009735:Nursing Homes; D011787:Quality of Health Care
keywords: Audit and Feedback; Clinical Microsystems; Cluster Randomized Controlled Trial; Nursing Homes; Performance; Quality Improvement; Quality of Care