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Cited by 67Health Policy Implementation ScienceHealth Sciences Research and EducationClinical practice guidelines implementation

Cluster randomized controlled trial of the effectiveness of audit and feedback and educational outreach on improving nursing practice and patient outcomes

Cheater, Francine M., Baker, Richard, Reddish, Stuart, Spiers, Nicola, Wailoo, Allan, Gillies, Clare, Robertson, Noelle, Cawood, Catherine·2006·Medical Care
DOI 10.1097/01.mlr.0000215919.89893.8a
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Abstract

BACKGROUND: Current understanding of implementation methods is limited, and research has focused on changing doctors' behaviors. AIM: Our aim was to evaluate the impact of audit and feedback and educational outreach in improving nursing practice and patient outcomes. METHODS: Using a factorial design, cluster randomized controlled trial, we evaluated 194 community nurses in 157 family practices and 1078 patients with diagnosis of urinary incontinence (UI) for nurses compliance with evidence-linked review criteria for the assessment and management of UI and impact on psychologic and social well-being and symptoms. In the outreach arms, nurses' self-reported barriers informed development of tailored strategies. RESULTS: In comparison with educational materials alone, the implementation methods tested did not improve care at 6 months follow-up. Moderate rates of improvement (10-17% of patients) in performance for the assessment of UI and greater rates of improvement (20-30% of patients) for the management of care were found but effects were similar across arms. Improvement in patient outcomes was more consistently positive for educational outreach than for audit and feedback but differences were not significant. Adjustment for caseload size, severity or duration of UI and patients' age did not alter results. CONCLUSIONS: Printed educational materials alone may be as effective as audit and feedback and educational outreach in improving nurses' performance and outcomes of care for people with UI. Greater understanding of the underlying processes in improving performance within multidisciplinary teams through further, theory-driven studies with "no intervention" control groups and longer follow-up are needed.

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Crossref · 10.1097/01.mlr.0000215919.89893.8a

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36 of 36 references verified0 citation errors · 0 not checkable

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  • For the eight studies with a non-tailored control intervention included in meta-regression, the pooled odds ratio was 1.79 (95% CI 1.06 to 3.01, P = 0.033).

    “Eight of these were included in a meta‐regression; the pooled odds ratio was 1.79 (95% CI 1.06 to 3.01, P value = 0.033) (Baker 2001; Beeckman 2013; Cheater 2006; Coenen 2004; Evans 1997; Fretheim 2006; Leviton 1999; Simon 2005).”

    From Tailored interventions to address determinants of practice (2015) · cites this paper as Cheater 2006

  • The overall risk of bias for Cheater 2006 was low (2 criteria unclear risk).

    “Risk of bias overall Low risk 2 criteria unclear risk”

    From Tailored interventions to address determinants of practice (2015) · cites this paper as Cheater 2006

  • Cheater 2006 found no statistically significant effect on management of urinary incontinence by nurses in primary care (median adjusted RD = -3.6%; no overall P value reported).

    “management of urinary incontinence by nurses in primary care (Cheater 2006: median adjusted RD = ‐3.6%; no overall P value reported)”

    From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Cheater 2006

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Authors
Cheater, F. M., Baker, R., Reddish, S., Spiers, N., Wailoo, A., Gillies, C., Robertson, N., & Cawood, C.
Affiliations
  • University of Leeds (GB)
  • University of Leicester (GB)
Corresponding author
Cheater, Francine M.
ORCID
Venue
Medical Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-06
Volume
44
Issue
6
Pages
542-551
ISSN
0025-7079 (ISSN-L)
DOI
10.1097/01.mlr.0000215919.89893.8a
OpenAlex
W2141492438
Cited by
67
References
36
Citations by year
2026: 2 · 2025: 4 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 5 · 2015: 5 · 2014: 5 · 2013: 4 · 2012: 4
FWCI
8.38
Type
journal article
Language
en
Open access
closed
Locations
  • Medical Care (publishedVersion)
  • PubMed (publishedVersion)
  • Leicester Research Archive (University of Leicester) (submittedVersion)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
audit and feedback, educational outreach, nursing practice, urinary incontinence, community nurses, general practice, implementation methodology, patient outcomes, printed educational materials, barriers to care, multidisciplinary team
MeSH terms
Education, Nursing, Continuing, Factor Analysis, Statistical, Family Practice, Feedback, Humans, Nursing Audit, Nursing Care, Quality of Health Care, Urinary Incontinence, Program Evaluation, Workload, Outcome Assessment, Health Care, Guideline Adherence

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