Table 2 Summary of included studies
From: Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis
Author | Year | Country | Study design and duration | Setting | Sample | Aim | Feedback approach |
|---|---|---|---|---|---|---|---|
Al Mohiza | 2016 | US | Cluster randomised trial 16 weeks | 15 outpatient neurological speciality clinics | 23 physical therapists | To implement and evaluate a quality improvement initiative in neurologic outpatient practice. | Process variation Feedback via email of educational material, education via webinar and brief assessment and reminders. |
Abdul-Baki | 2015 | US | Pre and post-study 4 years | 1 metropolitan endoscopy centre. | 17,526 colonoscopy reports | To assess whether public reporting of colonoscopy quality was associated with improvement in adenoma detection rate. | Reporting of quality measures Feedback via a published public report of each physician’s overall quality of colonoscopy score. |
Baker | 2008 | US | Pre and post-study 4 years | Cardiac Surgery Research database | 979 cardio-pulmonary bypass patients | To demonstrate the influence of automated generation of quality indicators for cardiopulmonary bypass and the implementation of a CQI program on the process of care. | Local QI feedback Feedback of data generated in an electronic report was discussed in small groups using QI methods for change. |
Caterson | 2015 | US | Methodological work | 1 tertiary hospital | Impact-based reconstruction | To investigate the standardised clinical assessment and management plan concept for breast reconstruction. | Guideline Feedback through local data coordinators to ensure physicians via their performance and record their decision-making. |
Cook | 2014 | US | Pre and post-study 2 months | 1 hospital progressive care unit | 86 baseline and 187 intervention surgical patients | To improve the quality of care in indwelling catheter use following surgery. | Health information technology -Decision support Rapid recovery pathway provided triggers for catheter removal. Educational reinforcement of the process provided to the team. |
Das | 2008 | UK | Between groups survey 1 year | British Society of Gastroenterology Membership | 228 gastroenterologists | To provide a review of the management of Barretts Esophagus in the UK and compare to national guidelines. | Reporting of quality measures The process of being in the AspECT trial in which sites received data of their practice was feedback of their practice. |
Dorfsman | 2018 | US | Pre and post-study 1 year | 3 emergency medicine programs in academic health centres | 31 residents | To use clinical practice variations as a training tool for residents. | Process variation Feedback via resident educational small group discussion sessions reviewing their practice. |
Deyo | 2000 | US | Pre and post-study 1 year | 22 health organisations including 12 hospitals, insurance plans, multicentred health services and independent services. | 3 team members from each of the 22 organisations | To use scientific evidence and behaviour change approaches to improve care for back pain. | Process variation Feedback through quarterly meetings reviewing each organisations data and group coaching sessions for each organisation. |
Dykes | 2005 | US | Pre and post-study 1 year | 1 community hospital | Pre-test sample - 90 heart failure patients over 65 and 55 control stroke patients over 65. Post-test sample - 96 heart failure patients over 65 and 75 control stroke patients over 65 | To examine interdisciplinary knowledge and adherence to core recommendations before and after HEART Failure Effectiveness and Leadership Team intervention. | Local QI feedback Multifaceted feedback approaches including small group discussion of practice data and information provision regarding best practice adapted to local context. |
Eagar | 2010 | Australia | Conceptual 18 months of data collection. | Palliative Care Outcomes Collaboration of 111 services | Benchmarking round 1–51 services; Benchmarking round 2–94 services | To measure the outcomes and quality of specialist palliative care services and to benchmark services on a national basis through an independent third party. | Reporting of quality measures Feedback on nationally reported data supported by quality improvement facilitators working with each service. |
Fredriksson | 2017 | Sweden | Cross sectional survey 1 month | 78 hospitals reporting to The Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography, 71 hospital clinics reporting to the Swedish Stroke Register and 31 hospital clinics reporting to the Swedish Lung Cancer Registry | 3–6 respondents from each organisation | To investigate the use of national quality registries in local quality improvement. | Reporting of quality measures Quality data available to organisations used in various ways by each for QI locally. |
Gaumer | 2008 | Egypt | Case study | 14 primary care clinics | NA | To develop a health information system to support quality improvement approaches to help clinicians understand practice variation. | Local QI feedback Feedback through a purpose-built electronic report on individual practice. |
Grey | 2014 | New Zealand | Cross sectional survey | Public and private health sector organisations in New Zealand | 28 stakeholders one-on-one feedback and 100+ meeting attendees | To gain feedback about the interpretation and use of Atlas data for frontline quality improvement. | Reporting of quality measures One to one feedback and multiple group feedback and discussion events. |
Griffiths | 2017 | UK | Pre and post-study 7 months | Royal College of Pathologists | Training event and grand rounds resulted in 50 checklists completed - no data re attendance of these. | To investigate the feasibility of developing key performance indicators to measure adherence to a specified process of histopathological surgical dissection. | Local QI feedback Key performance indicators used to create checklists to reduce UCV. Training events held on the checklists. |
Ip | 2014 | US | Pre and post-study 21 months | 183 practices within an integrated health system | 2240 adult lower back pain patients between 2007 and 2010 | To examine the impact of a multi-faceted clinical decision support intervention on MRI use in patients with lower back pain. | Health information technology -Decision support Feedback through peer to peer consultation and electronic practice variation reports provided to clinicians. |
Kelly | 2016 | Australia | Pre and post-study with qualitative interview 1 year | 48 hospitals | 149,888 patients undergoing percutaneous coronary intervention 2002–2004 | To demonstrate that meaningful interpretation from funnel plots can be derived from a New York dataset. | Local QI feedback Awareness activities and educational sessions. |
Lee | 2016 | US | Pre and post-study 3 years | Community and specialist inflammatory bowel disease clinics in one health service | 50 electronic medical charts of 6 gastroenterology fellows | To incorporate an in-service educational session on IBD health maintenance to increase trainees’ knowledge and awareness. | Process variation Feedback through in-service educational sessions. |
McFadyen | 2015 | Canada | Pre and post-study 14 months | One provincial health region | 56 clinicians - general surgeons, surgical oncologists, urologists and pathologists. | To provide clinicians with an individualised feedback report to improve quality. | Local QI feedback Confidential individual electronic provider reports of their practice data. |
Miller | 2011 | US | Pre and post-study 16 months | Three urology practices. | 858 urology presentations | To improve patterns of care for radiological staging of newly diagnosed prostate cancer. | Local QI feedback Feedback activities included review of data against clinical guidelines, local meetings and collaborative-wide teleconference discussions. |
Min | 2017 | Canada | Pre and post-study 3 years | One major acute care centre. | 43 emergency physicians | To determine whether point of care clinical decision support can effectively reduce inappropriate medical imaging of patients who present to the emergency room with low back pain. | Health information technology - Decision support Checklist in the computerised order entry system developed by working group of clinicians and embedded to prompt practice change. |
Nguyen | 2007 | US | Pre and post-study 4 years | 44 facilities in the Northwest Renal Network | 4 workshops attended by - 36 nephrologists, 16 VA surgeons and 1 radiologist; 35 physicians responded to the follow-up survey | To use educational interventions to promote arteriovenous fistula creation. | Process variation Workshop meetings across the network. |
Nordstrom | 2016 | US | Pre and post-study 9 months | Cohorts of physician practices across Vermont | 28 physician practices in 4 cohorts | To examine physician engagement and change in buprenorphine practice | Process variation Learning collaborations of face to face and teleconference sessions. |
Rubin | 2015 | UK | Mixed methods 4 years | 8179 primary care practices | 92 interviewees - GP, GP cancer leads, public health staff and cancer network staff. | To explore whether quality improvement activities were associated with a change in referral practice. | Local QI feedback GP leads in cancer networks across the country used different QI approaches. |
Smith | 2013 | Australia | Pre and post-study 9 years 3 months | Cardiac surgical unit at one hospital | 5265 consecutive cardiac procedures 2003–2012 | To explore the application of graphical statistical process techniques to inform routine cardiac surgical mortality and morbidity review processes. | Local QI feedback Group reviews of control charts and funnel plots. |
Stafford | 2003 | US | Pre and post-study 9 months | 117 primary care providers associated with one hospital | 105,682 patients and 511,328 patient visits | To evaluate the impact of a feedback intervention on reducing rate and variation of ECG orders. | Local QI feedback Quality improvement team at each hospital presented to clinicians their performance data. |
Tavender | 2015 | UK | Conceptual | One emergency department | NA | To develop a targeted theory-based intervention that improves the management of mild traumatic brain injury. | Local QI feedback Behaviour change techniques from the theoretical domains framework. |
Tomson | 2013 | The Netherlands | Narrative review | NA | NA | To describe quality improvement techniques that maintain clinical quality. | Local QI feedback Multiple approaches discussed through included articles. |