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. 2021 Dec 4;22(1):870.
doi: 10.1186/s13063-021-05819-z.

Performance feedback on the quality of care in hospitals performing thrombectomy for ischemic stroke (PERFEQTOS): protocol of a stepped wedge cluster randomized trial

Marzyeh Amini  1 , Sanne J den Hartog  1   2   3 , Nikki van Leeuwen  1 , Frank Eijkenaar  4 , Laurien S Kuhrij  5   6 , Lotte J Stolze  5   6 , Paul J Nederkoorn  6 , Hester F Lingsma  1 , Adriaan C G M van Es  7 , Ido R van den Wijngaard  8   9 , Aad van der Lugt  3 , Diederik W J Dippel  2 , Bob Roozenbeek  10   11 ; PERFEQTOS Investigators
Collaborators, Affiliations

Performance feedback on the quality of care in hospitals performing thrombectomy for ischemic stroke (PERFEQTOS): protocol of a stepped wedge cluster randomized trial

Marzyeh Amini et al. Trials. .

Abstract

Background: Although the provision of performance feedback to healthcare professionals based on data from quality registries is common practice in many fields of medicine, observational studies of its effect on the quality of care have shown mixed results. The objective of this study is to evaluate the effect of performance feedback on the quality of care for acute ischemic stroke.

Methods: PERFEQTOS is a stepped wedge cluster randomized trial in 13 hospitals in the Netherlands providing endovascular thrombectomy for ischemic stroke. The primary outcome is the hospital's door-to-groin time. The study starts with a 6-month period in which none of the hospitals receives the performance feedback intervention. Subsequently, every 6 months, three or four hospitals are randomized to cross over from the control to the intervention conditions, until all hospitals receive the feedback intervention. The feedback intervention consists of a dashboard with quarterly reports on patient characteristics, structure, process, and outcome indicators related to patients with ischemic stroke treated with endovascular thrombectomy. Hospitals can compare their present performance with their own performance in the past and with other hospitals. The performance feedback is provided to local quality improvement teams in each hospital, who define their own targets on specific indicators and develop performance improvement plans. The impact of the performance feedback and improvement plans will be evaluated by comparing the primary outcome before and after the intervention.

Discussion: This study will provide evidence on the effectiveness of performance feedback to healthcare providers. The results will be actively disseminated through peer-reviewed journals, conference presentations, and various stakeholder engagement activities.

Trial registration: Netherlands Trial Register NL9090 . Registered on December 3, 2020.

Keywords: Endovascular thrombectomy; Ischemic stroke; Performance feedback; Quality of care; Stepped wedge cluster randomized trial.

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Conflict of interest statement

The authors and principal investigators of the trial declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
SPIRIT figure. Schematic visualization of stepped wedge cluster randomized trial control and intervention allocation, follow-up, and reporting of the study
Fig. 2
Fig. 2
Specialized EVT hospitals in the Netherlands which participate in this study
Fig. 3
Fig. 3
Screenshots of the PERFEQTOS dashboard (generated from anonymous data)
Fig. 4
Fig. 4
The performance feedback cycle to improve each hospital’s performance. Adapted from Carver and Scheier’s Control Theory [36]
See this image and copyright information in PMC

References

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