Enhancing Quality Care in Ontario Long-Term Care Homes Through Audit and Feedback for Physicians.

The province of Ontario in Canada is an example of a jurisdiction that is using a specific quality improvement mechanism, known as “audit and feedback,” to help clinicians enhance the care they provide to long-term care (LTC) home residents. This program, launched in 2015, is unique in that the reports are provided across an entire jurisdiction. These reports were co-designed with clinicians, including medical directors, scientists, and other stakeholders, and are updated regularly to maintain their relevance to medical practice in LTC. The data for the reports is calculated using record linkage with available administrative data sources. The reports are updated with new data 4 times each year and emailed directly to physicians who have requested their report. The reports are designed to have an overall dashboard summarizing the practice level data with a comparison to all physicians in Ontario. More detailed information on their data such as trend data and resources for quality improvement are found in subsequent pages of the report. These reports are a tool to support physicians in quality improvement efforts in their LTC practice. We believe the role of a medical director is very important in both the uptake and use of these reports as the medical director would act as a trusted advisor who can influence quality of care overall within an LTC home. We are also testing a new format for delivering the reports in an interactive online format that enables more options for viewing practice data. Initial evaluation of these reports shows that there is a statistically significant impact on reducing the prescription of antipsychotic medications in LTC homes. In future, we hope to see a larger effect on the latest topic included in the reports: antibiotic prescribing.