Open Access Open Badges Research article

Unregulated provider perceptions of audit and feedback reports in long-term care: cross-sectional survey findings from a quality improvement intervention

Kimberly D Fraser1*, Hannah M O’Rourke1, Melba Andrea B Baylon1, Anne-Marie Boström123 and Anne E Sales14

Author Affiliations

1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada

2 Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden

3 Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden

4 School of Nursing, University of Michigan, Ann Arbor, MI, USA

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BMC Geriatrics 2013, 13:15  doi:10.1186/1471-2318-13-15

Published: 13 February 2013



Audit with feedback is a moderately effective approach for improving professional practice in other health care settings. Although unregulated caregivers give the majority of direct care in long-term care settings, little is known about how they understand and perceive feedback reports because unregulated providers have not been directly targeted to receive audit with feedback in quality improvement interventions in long-term care. The purpose of this paper is to describe unregulated care providers’ perceptions of usefulness of a feedback report in four Canadian long-term care facilities.


We delivered monthly feedback reports to unregulated care providers for 13 months in 2009–2010. The feedback reports described a unit’s performance in relation to falls, depression, and pain as compared to eight other units in the study. Follow-up surveys captured participant perceptions of the feedback report. We conducted descriptive analyses of the variables related to participant perceptions and multivariable logistic regression to assess the association between perceived usefulness of the feedback report and a set of independent variables.


The vast majority (80%) of unregulated care providers (n = 171) who responded said they understood the reports. Those who discussed the report with others and were interested in other forms of data were more likely to find the feedback report useful for making changes in resident care.


This work suggests that unregulated care providers can understand and feel positively about using audit with feedback reports to make changes to resident care. Further research should explore ways to promote fuller engagement of unregulated care providers in decision-making to improve quality of care in long-term care settings.

Long-term care; Unregulated care provider; Quality of care; Audit and feedback