The literature suggests that audit and

The literature suggests that audit and feedback is more effective when accompanied by either active interventions (such as educational outreach, integration within an overall quality improvement framework), or passive interventions (such as publication of performance), with active interventions generally being more successful then passive interventions [15,18-20]. So far, only audit- and

feedback strategies using cumulative scores relating to care performances of care teams have been reported previously in the literature (e.g., Zuidgeest et al. [21]). However, this audit- and feedback Inhibitors,research,lifescience,medical strategy is time consuming due to the administrative tasks involved, which potentially creates barriers for the nursing homes to use audit- and feedback for care quality improvement. Therefore, a feedback strategy based on discussing evaluations on a patient level, is an appealing, Inhibitors,research,lifescience,medical and possibly less time consuming, alternative design. Such patient specific audit- and feedback also allows for individual care workers to relate Inhibitors,research,lifescience,medical more directly the feedback to their own care performance. Due to a lack of studies that directly compare different strategies of audit and feedback, evidence for the effectiveness of different audit and feedback strategies is limited [15,19], and this includes the nursing

home setting. Moreover, the influence of the organizational context on audit- and feedback and its implementation has not been addressed. More generally, earlier work in the area of evidence-based clinical practices in health care organizations found three organizational elements to influence implementation processes of evidence-based Inhibitors,research,lifescience,medical clinical practices: active leadership, process adaptation and involvement of management structures and processes [22]. Implementation

of guidelines is affected by the specific characteristics of the guidelines, the target group and of the social or environmental context [23]. The aim of the Feedback on End-of-Life care in dementia (FOLlow-up) project is to assess Inhibitors,research,lifescience,medical the effect of the implementation of two audit- and feedback strategies on the quality of care and quality of dying of nursing home residents with dementia: a generic feedback strategy using cumulative care performance scores generated by a feedback DZNeP mouse program, and a patient specific strategy. Effects of implementation are assessed with the End-of-Life in Dementia – Satisfaction ADP ribosylation factor With Care (EOLD-SWC) scale and the End-of-Life in Dementia – Comfort Assessment in Dying (EOLD-CAD) scale [24]. Families evaluate and provide feedback on the quality of end-of-life care and the quality of dying of nursing home residents with dementia, as families’ perceptions are intrinsically valuable in palliative care [25]. These instruments had the best psychometric properties and feasibility for use among bereaved family members [26-28].

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