Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya

Susan Gachau; Philip Ayieko; David Gathara; Paul Mwaniki; Morris Ogero; Samuel Akech; Michuki Maina; Ambrose Agweyu; Jacquie Oliwa; Thomas Julius; Lucas Malla; James Wafula; George Mbevi; Grace Irimu; Mike English; Boniface Makone; Mercy Terer; Timothy Tuti; Abraham Lagat; Samuel N'gar; Ivan Muroki; David Kimutai; Loice Mutai; Caren Emadau; Cecilia Mutiso; Charles Nzioki; Francis Kanyingi; Agnes Mithamo; Margaret Kuria; Sam Otido; Grace Wachira; Alice Kariuki; Peris Njiiri; Rachel Inginia; Melab Musabi; Hilda Odeny; Grace Ochieng; Lydia Thuranira; Priscilla Oweso; Ernest Namayi; Benard Wambani; Samuel Soita; Joseph Nganga; Margaret Waweru; John Karanja; Susan Owano; Esther Muthiani; Alfred Wanjau; Larry Mwallo; Lydia Wanjiru

doi:10.1136/bmjgh-2017-000468

Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya

Susan Gachau
, Philip Ayieko
, David Gathara
, Paul Mwaniki
, Morris Ogero
, Samuel Akech
, Michuki Maina
, Ambrose Agweyu
, Jacquie Oliwa
, Thomas Julius
, Lucas Malla
, James Wafula
, George Mbevi
, Grace Irimu
, Mike English
, Boniface Makone
, Mercy Terer
, Timothy Tuti
, Abraham Lagat
, Samuel N'gar

Ivan Muroki, David Kimutai, Loice Mutai, Caren Emadau, Cecilia Mutiso, Charles Nzioki, Francis Kanyingi, Agnes Mithamo, Margaret Kuria, Sam Otido, Grace Wachira, Alice Kariuki, Peris Njiiri, Rachel Inginia, Melab Musabi, Hilda Odeny, Grace Ochieng, Lydia Thuranira, Priscilla Oweso, Ernest Namayi, Benard Wambani, Samuel Soita, Joseph Nganga, Margaret Waweru, John Karanja, Susan Owano, Esther Muthiani, Alfred Wanjau, Larry Mwallo, Lydia Wanjiru

Wellcome Trust Research Laboratories Nairobi
University of Oxford
University of Nairobi
Vihiga County Hospital
Kakamega County Hospital
Mbagathi County Hospital
Mama Lucy Kibaki Hospital
Machakos Level 5 County Referral Hospital
Nyeri County Hospital
Kisumu East County Hospital
Embu County Hospital
Karatina County Hospital
Kerugoya County Hospital
Kitale County Hospital
Busia County Hospital
Kiambu County Hospital
Mbale Rural Health and Demonstration Centre
Kakamega Provincial General Hospital
Mbagathi District Hospital
Nyeri Level 5 hospital
Kisumu East District Hospital
Embu Provincial General Hospital

Research output: Contribution to journal › Article › peer-review

30 Citations (Scopus)

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.

Original language	English
Article number	e000468
Journal	BMJ Global Health
Volume	2
Issue number	4
DOIs	https://doi.org/10.1136/bmjgh-2017-000468
Publication status	Published - 1 Jan 2017
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1136/bmjgh-2017-000468

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Gachau, S., Ayieko, P., Gathara, D., Mwaniki, P., Ogero, M., Akech, S., Maina, M., Agweyu, A., Oliwa, J., Julius, T., Malla, L., Wafula, J., Mbevi, G., Irimu, G., English, M., Makone, B., Terer, M., Tuti, T., Lagat, A., ... Wanjiru, L. (2017). Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya. BMJ Global Health, 2(4), Article e000468. https://doi.org/10.1136/bmjgh-2017-000468

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title = "Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya",

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.",

author = "Susan Gachau and Philip Ayieko and David Gathara and Paul Mwaniki and Morris Ogero and Samuel Akech and Michuki Maina and Ambrose Agweyu and Jacquie Oliwa and Thomas Julius and Lucas Malla and James Wafula and George Mbevi and Grace Irimu and Mike English and Boniface Makone and Mercy Terer and Timothy Tuti and Abraham Lagat and Samuel N'gar and Ivan Muroki and David Kimutai and Loice Mutai and Caren Emadau and Cecilia Mutiso and Charles Nzioki and Francis Kanyingi and Agnes Mithamo and Margaret Kuria and Sam Otido and Grace Wachira and Alice Kariuki and Peris Njiiri and Rachel Inginia and Melab Musabi and Hilda Odeny and Grace Ochieng and Lydia Thuranira and Priscilla Oweso and Ernest Namayi and Benard Wambani and Samuel Soita and Joseph Nganga and Margaret Waweru and John Karanja and Susan Owano and Esther Muthiani and Alfred Wanjau and Larry Mwallo and Lydia Wanjiru",

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journal = "BMJ Global Health",

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Gachau, S, Ayieko, P, Gathara, D, Mwaniki, P, Ogero, M, Akech, S, Maina, M, Agweyu, A, Oliwa, J, Julius, T, Malla, L, Wafula, J, Mbevi, G, Irimu, G, English, M, Makone, B, Terer, M, Tuti, T, Lagat, A, N'gar, S, Muroki, I, Kimutai, D, Mutai, L, Emadau, C, Mutiso, C, Nzioki, C, Kanyingi, F, Mithamo, A, Kuria, M, Otido, S, Wachira, G, Kariuki, A, Njiiri, P, Inginia, R, Musabi, M, Odeny, H, Ochieng, G, Thuranira, L, Oweso, P, Namayi, E, Wambani, B, Soita, S, Nganga, J, Waweru, M, Karanja, J, Owano, S, Muthiani, E, Wanjau, A, Mwallo, L & Wanjiru, L 2017, 'Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya', BMJ Global Health, vol. 2, no. 4, e000468. https://doi.org/10.1136/bmjgh-2017-000468

TY - JOUR

T1 - Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya

AU - Gachau, Susan

AU - Ayieko, Philip

AU - Gathara, David

AU - Mwaniki, Paul

AU - Ogero, Morris

AU - Akech, Samuel

AU - Maina, Michuki

AU - Agweyu, Ambrose

AU - Oliwa, Jacquie

AU - Julius, Thomas

AU - Malla, Lucas

AU - Wafula, James

AU - Mbevi, George

AU - Irimu, Grace

AU - English, Mike

AU - Makone, Boniface

AU - Terer, Mercy

AU - Tuti, Timothy

AU - Lagat, Abraham

AU - N'gar, Samuel

AU - Muroki, Ivan

AU - Kimutai, David

AU - Mutai, Loice

AU - Emadau, Caren

AU - Mutiso, Cecilia

AU - Nzioki, Charles

AU - Kanyingi, Francis

AU - Mithamo, Agnes

AU - Kuria, Margaret

AU - Otido, Sam

AU - Wachira, Grace

AU - Kariuki, Alice

AU - Njiiri, Peris

AU - Inginia, Rachel

AU - Musabi, Melab

AU - Odeny, Hilda

AU - Ochieng, Grace

AU - Thuranira, Lydia

AU - Oweso, Priscilla

AU - Namayi, Ernest

AU - Wambani, Benard

AU - Soita, Samuel

AU - Nganga, Joseph

AU - Waweru, Margaret

AU - Karanja, John

AU - Owano, Susan

AU - Muthiani, Esther

AU - Wanjau, Alfred

AU - Mwallo, Larry

AU - Wanjiru, Lydia

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

U2 - 10.1136/bmjgh-2017-000468

DO - 10.1136/bmjgh-2017-000468

M3 - Article

VL - 2

JO - BMJ Global Health

JF - BMJ Global Health

IS - 4

M1 - e000468

ER -

Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya

Abstract

UN SDGs

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