Abstract
Background and Rationale: There is evidence of a gap
between the rehabilitation that stroke patients receive and what
that is recommended in clinical practice guidelines (CPGs). Audit/
feedback on adherence to CPGs are usually provided in limited
doses with great expectation for change in behaviour. This study
evaluated the effects of a sustained, fortnightly intervention of audit/
feedback on adherence to stroke rehabilitation CPGs.
Methods: Using a periodic service review methodology, rehabilitation
care was audited fortnightly for a year against ten published
CPGs, including the National Stroke Foundation Rehabilitation
guidelines. Together these CPGs produced n = 132 observable
criteria. Each fortnight, two patients were randomly selected and
audited against the observable criteria. Adherence was graphed
and summarised into rehabilitation intervention areas, and feedback
sessions were then facilitated with clinicians. These feedback
sessions summarised the observed clinical adherence and, using a
positive behavioural support model, encouraged clinicians to adjust
their performance.
Results: Twenty three audit/feedback cycles were completed
during the study. Adherence to the CPGs was observed during the
study period, resulting in an improvement from 34% to 96% adherence
to the possible 132 guidelines (baseline to end of year). Thus,
using an audit/feedback intervention achieved a 54% increase in
adherence to CGPs (p = 0.0001).
Conclusion: Findings have demonstrated that it is possible
to improve clinical adherence to rehabilitation CPGs using an intensive
audit/feedback method. To achieve sustainable change in
practice we recommend that audit/feedback is incorporated into
usual rehabilitation, and thus, becomes the responsibility of clinicians
rather than researchers.
between the rehabilitation that stroke patients receive and what
that is recommended in clinical practice guidelines (CPGs). Audit/
feedback on adherence to CPGs are usually provided in limited
doses with great expectation for change in behaviour. This study
evaluated the effects of a sustained, fortnightly intervention of audit/
feedback on adherence to stroke rehabilitation CPGs.
Methods: Using a periodic service review methodology, rehabilitation
care was audited fortnightly for a year against ten published
CPGs, including the National Stroke Foundation Rehabilitation
guidelines. Together these CPGs produced n = 132 observable
criteria. Each fortnight, two patients were randomly selected and
audited against the observable criteria. Adherence was graphed
and summarised into rehabilitation intervention areas, and feedback
sessions were then facilitated with clinicians. These feedback
sessions summarised the observed clinical adherence and, using a
positive behavioural support model, encouraged clinicians to adjust
their performance.
Results: Twenty three audit/feedback cycles were completed
during the study. Adherence to the CPGs was observed during the
study period, resulting in an improvement from 34% to 96% adherence
to the possible 132 guidelines (baseline to end of year). Thus,
using an audit/feedback intervention achieved a 54% increase in
adherence to CGPs (p = 0.0001).
Conclusion: Findings have demonstrated that it is possible
to improve clinical adherence to rehabilitation CPGs using an intensive
audit/feedback method. To achieve sustainable change in
practice we recommend that audit/feedback is incorporated into
usual rehabilitation, and thus, becomes the responsibility of clinicians
rather than researchers.
Original language | English |
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DOIs | |
Publication status | Published - 2016 |
Event | Annual Conference of the Asia Pacific Stroke Conference (APSO) Combined with Stroke Society of Australasia - Duration: 14 Jul 2016 → 17 Jul 2016 |
Conference
Conference | Annual Conference of the Asia Pacific Stroke Conference (APSO) Combined with Stroke Society of Australasia |
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Period | 14/07/16 → 17/07/16 |