Effect of Enhanced Feedback to Hospitals in an Emerging Clinical Information Network

KEMRI-Wellcome Trust Collaborative Research Program900 enrolled

Overview

A cluster randomised pragmatic trial will be conducted within an emerging clinical information network composed of 12 Kenyan county hospitals. Hospitals will be randomised to an enhanced feedback intervention delivered over a nine-month period and compared to standard feedback. The trial to be implemented during a phase of implementing change in guideline recommendations for pneumonia will assess the impact of enhanced feedback on hospital uptake of the revised pneumonia treatment recommendations.

The international guidelines for the classification and treatment of childhood pneumonia were revised recently and in Kenya the national guidelines changed in February 2016. We designed an enhanced feedback intervention aimed at improving uptake of the revised pneumonia treatment policy within a clinical network of 12 Kenyan county referral hospitals. Hospitals were randomized to receive either enhanced feedback (n = 6 hospitals) or standard feedback (n = 6 hospitals) delivered over a six-month period following nationwide pneumonia treatment policy change. The primary outcome is the proportion of all pneumonia admissions (fulfilling criteria for treatment with oral amoxicillin) who are correctly classified and treated using new guideline recommendations. The proportion of treatment change from oral amoxicillin to alternative antibiotics for pneumonia (considered a proxy measure of treatment failure) will be reported as a secondary outcome.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

900

Conditions

Pneumonia

Interventions

Enhanced feedbackBEHAVIORAL

Hospital level feedback delivered every month through paediatrician on the level of adherence to revised pneumonia treatment recommendations.

Standard feedbackBEHAVIORAL

Hospital level feedback delivered every two months through paediatrician on the performance of multiple paediatric care indicators for managing severely ill children.

Eligibility

Sex: ALLMin age: 2 MonthsMax age: 59 Months

Medical Language ↔ Plain English

Inclusion Criteria: * Children aged 2 to 59 months admitted to participating network hospitals with WHO pneumonia diagnosis eligible for treatment with oral amoxicillin Exclusion Criteria: * Children aged 2 to 59 months with WHO pneumonia diagnosis and co-morbid illnesses requiring intravenous antibiotic treatment including severe acute malnutrition, bacteraemia, meningitis, or * children presenting with pneumonia and tuberculosis or cough lasting more than 2 weeks, or severe malaria

Locations (12)

Kerugoya County Hospital

Kerugoya, Kerugoya, Kenya

Busia County Hospital

Busia, Kenya

Embu County Hospital

Embu, Kenya

Kakamega County Referral Hospital

Kakamega, Kenya

Outcomes

Primary Outcomes

Pneumonia classification and treatment

The proportion of all pneumonia admissions (fulfilling criteria for treatment with oral amoxicillin) who are correctly classified and treated using new guideline recommendations

Time frame: 9 months

Secondary Outcomes

Antibiotic change

The proportion of treatment change from oral amoxicillin to alternative antibiotics for pneumonia (considered a proxy measure of treatment failure)

Time frame: 9 months

Data from ClinicalTrials.gov

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