The effectiveness of audit and feedback to reduce practice variation in sciatica treatment

Rationale: In international guidelines, it is recommended to perform an additional watchful
waiting strategy up to 3 months for sciatica. Additionally, it is recommended to perform
surgery before 20 weeks after onset. If patients do not present with a cauda equina
syndrome, paresis or severe pain, it is recommended to keep patients in first-line care up to
8 weeks after onset. Despite these recommendations, practice variation remains
problematic. It is thought that awareness can reduce practice variation. Therefore, this study
aims to reduce practice variation in sciatica treatment by using audit and feedback including
the identification of barriers and facilitators. Since practice variation might partly be caused
by differences in referral patterns and patient preferences, we also investigate whether
differences in general practitioners (GPs) referral patterns are present, whether variability
among practitioners within a region is associated with higher levels of surgery in this area,
and to explore patient involvement in treatment process and the influence of patient
preferences on decision making.
Study design and population: The study consists of two phases: 1. Development and
evaluation of an audit and feedback strategy to reduce practice variation in sciatica
treatment. We will perform a randomized controlled trial on the effect of the implementation
strategy. Twelve randomly selected hospitals from the LOGEX Benchmark Database will
receive an invitation to participate in our study. We will compare clinical practice before and
after the intervention in the participating hospitals, and we will compare the intervention
hospitals with the control group, which consists all other hospitals from the LOGEX
Benchmark Database, 2. Analysis of practice variation in GPs referral pattern using data
from the ELAN Datawarehouse (Den Haag) and additionally presenting the outcomes to the
GP practices included in the analysis
Main study parameters/endpoints: Main outcome is practice variation in sciatica treatment
before and after giving audit and feedback to neurosurgeons and neurologists. Also, changes
in clinical practice (both treatment choices and treatment processes) will be analysed using
difference-in-difference analysis comparing intervention hospitals with the control group.
Hospital characteristics will be compared with the opinion of physicians on the topic.
Furthermore, we will evaluate practice variation in GP practices concerning sciatica
treatment.

Providing feedback on practice patterns and practice variation will reduce variation between hospitals

We would like to measure 6 months prior to the study and 6 months after.

Providing audit and feedback for a year, every quarter