Skip to main content

Table 2 Summary of included studies

From: Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis

AuthorYearCountryStudy design and durationSettingSampleAimFeedback approach
Al Mohiza2016USCluster randomised trial
16 weeks
15 outpatient neurological speciality clinics23 physical therapistsTo 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-Baki2015USPre and post-study
4 years
1 metropolitan endoscopy centre.17,526 colonoscopy reportsTo 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.
Baker2008USPre and post-study
4 years
Cardiac Surgery Research database979 cardio-pulmonary bypass patientsTo 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.
Caterson2015USMethodological work1 tertiary hospitalImpact-based reconstructionTo 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.
Cook2014USPre and post-study
2 months
1 hospital progressive care unit86 baseline and 187 intervention surgical patientsTo 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.
Das2008UKBetween groups survey 1 yearBritish Society of Gastroenterology Membership228 gastroenterologistsTo 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.
Dorfsman2018USPre and post-study 1 year3 emergency medicine programs in academic health centres31 residentsTo use clinical practice variations as a training tool for residents.Process variation
Feedback via resident educational small group discussion sessions reviewing their practice.
Deyo2000USPre and post-study 1 year22 health organisations including 12 hospitals, insurance plans, multicentred health services and independent services.3 team members from each of the 22 organisationsTo 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.
Dykes2005USPre and post-study 1 year1 community hospitalPre-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 65To 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.
Eagar2010AustraliaConceptual 18 months of data collection.Palliative Care Outcomes Collaboration of 111 servicesBenchmarking round 1–51 services; Benchmarking round 2–94 servicesTo 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.
Fredriksson2017SwedenCross sectional survey 1 month78 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 Registry3–6 respondents from each organisationTo 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.
Gaumer2008EgyptCase study14 primary care clinicsNATo 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.
Grey2014New ZealandCross sectional surveyPublic and private health sector organisations in New Zealand28 stakeholders one-on-one feedback and 100+ meeting attendeesTo 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.
Griffiths2017UKPre and post-study 7 monthsRoyal College of PathologistsTraining 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.
Ip2014USPre and post-study 21 months183 practices within an integrated health system2240 adult lower back pain patients between 2007 and 2010To 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.
Kelly2016AustraliaPre and post-study with qualitative interview 1 year48 hospitals149,888 patients undergoing percutaneous coronary intervention 2002–2004To demonstrate that meaningful interpretation from funnel plots can be derived from a New York dataset.Local QI feedback
Awareness activities and educational sessions.
Lee2016USPre and post-study 3 yearsCommunity and specialist inflammatory bowel disease clinics in one health service50 electronic medical charts of 6 gastroenterology fellowsTo incorporate an in-service educational session on IBD health maintenance to increase trainees’ knowledge and awareness.Process variation
Feedback through in-service educational sessions.
McFadyen2015CanadaPre and post-study 14 monthsOne provincial health region56 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.
Miller2011USPre and post-study 16 monthsThree urology practices.858 urology presentationsTo 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.
Min2017CanadaPre and post-study 3 yearsOne major acute care centre.43 emergency physiciansTo 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.
Nguyen2007USPre and post-study 4 years44 facilities in the Northwest Renal Network4 workshops attended by - 36 nephrologists, 16 VA surgeons and 1 radiologist; 35 physicians responded to the follow-up surveyTo use educational interventions to promote arteriovenous fistula creation.Process variation
Workshop meetings across the network.
Nordstrom2016USPre and post-study 9 monthsCohorts of physician practices across Vermont28 physician practices in 4 cohortsTo examine physician engagement and change in buprenorphine practiceProcess variation
Learning collaborations of face to face and teleconference sessions.
Rubin2015UKMixed methods 4 years8179 primary care practices92 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.
Smith2013AustraliaPre and post-study 9 years 3 monthsCardiac surgical unit at one hospital5265 consecutive cardiac procedures 2003–2012To 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.
Stafford2003USPre and post-study 9 months117 primary care providers associated with one hospital105,682 patients and 511,328 patient visitsTo 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.
Tavender2015UKConceptualOne emergency departmentNATo 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.
Tomson2013The NetherlandsNarrative reviewNANATo describe quality improvement techniques that maintain clinical quality.Local QI feedback
Multiple approaches discussed through included articles.