Precision Feedback to Improve Health Care Quality

A Scalable Service to Improve Health Care Quality Through Precision Audit and Feedback: a Cluster-randomized Controlled Trial

This cluster-randomized trial will assess the effectiveness of a precision feedback service on anesthesia provider performance. The precision feedback service enhances a standard audit and feedback (A&F) email with a brief message and visual display about high-value performance information. The control arm will receive a standard "one size fits most" A&F email that is currently sent to anesthesia providers each month. Hypothesis: Providers receiving precision feedback will increase a) care quality for improvable measures and b) email engagement (click-through and dashboard login rates) when compared with providers receiving standard A&F emails. The study investigators will assess unintended consequences in a mixed-methods process evaluation.

Study Overview

• Status: Active, not recruiting
• Conditions: Anesthesia Care Quality
• Intervention / Treatment: Behavioral: precision-enhanced feedback email messages; Behavioral: standard feedback email messages

• Study Type: Interventional
• Enrollment (Estimated): 3500
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Michigan
    • Ann Arbor, Michigan, United States, 48109
      • University of Michigan

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria (assessed before interventional period):

• Participation in the Multicenter Perioperative Outcomes Group (MPOG) provider feedback email program.

Exclusion Criteria (assessed after interventional period):

• Ended participation in the MPOG provider feedback email program for any reason during the study period
• Changed professional roles (e.g. transitioned from resident to attending) before the end of the intervention period
• Changed institutions during the study period
• Had no institution-selected quality measures in common between the pre-intervention and intervention period
• Were not candidates to receive a precision feedback email for the majority of the trial.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: precision-enhanced feedback email messages; Providers receive an enhanced monthly email containing precision audit and feedback (A&F).	Behavioral: precision-enhanced feedback email messages; Providers receive customized messages prioritizing metrics in an optimal formatting.
Active Comparator: standard feedback email messages; Providers receive the standard "one size fits most" A&F monthly email.	Behavioral: standard feedback email messages; Providers receive metrics in a common format.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measure success rate (M) for operative cases of anesthesia care providers	The primary outcome for the cluster-randomized controlled trial is the measure success rate (M) for operative cases of anesthesia care providers, where: M = sum of all operative case measurement successes / number of all operative case measurements The measures included in each provider's measure success rate will be all improvable process measures that meet the following inclusion criteria: A provider's cases were included for the measure during both the 6-month pre-intervention period and during the 6-month intervention period.; Average performance for the measure is below 90% during the baseline period, based on the MPOG threshold for most process measures.; The measure was included in at least one provider feedback email during the intervention period. The investigators will exclude measures of clinical outcomes (also called "inverse measures") in this study that are less within the control of providers.	Up to 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Average email click-through rate (CTR)	CTR = 100 x (number of recipient's emails with a clicked link) / (total number of emails)	Up to 6 months
Average dashboard login rate (L)	L = 100 x (number of months with an email recipient's dashboard login event) / (total number of months)	Up to 1 year

Collaborators and Investigators

• Sponsor: University of Michigan
• Collaborators: National Library of Medicine (NLM)
• Investigators: Principal Investigator: Zach Landis-Lewis, University of Michigan

Publications and helpful links

General Publications

• Landis-Lewis Z, Flynn A, Janda A, Shah N. A Scalable Service to Improve Health Care Quality Through Precision Audit and Feedback: Proposal for a Randomized Controlled Trial. JMIR Res Protoc. 2022 May 10;11(5):e34990. doi: 10.2196/34990.

Study record dates

Study Major Dates

• Study Start (Actual): May 6, 2024
• Primary Completion (Actual): November 30, 2024
• Study Completion (Estimated): June 1, 2025

Study Registration Dates

• First Submitted: June 20, 2023
• First Submitted That Met QC Criteria: June 20, 2023
• First Posted (Actual): June 28, 2023

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 20, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: Anesthesiology; Audit and feedback; Learning health system
• Other Study ID Numbers: HUM00194224; R01LM013894-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No