Confidential physician feedback reports seek to make physicians aware of their individual performance on one or more metrics in order to influence their clinical practice and improve performance. There is growing interest in feedback reports and their potential to improve performance, fueled in part by:
- Recognition that health care quality is not where we as a Nation want it to be, and the pace of improvement is unacceptably, unnecessarily slow;
- Concern about health care waste associated with inappropriate use, underuse, and overuse of services;
- Dissatisfaction with the time it takes to effectively integrate clinical advances into routine medical practice;
- The reality that collective improvement is merely the sum of improvements made by individual physicians, individual practices, and hospitals, one at a time;
- Belief that physicians’ awareness of their own performance builds a critical and necessary foundation for improvement; and
- Proliferation of payment incentives tied to performance metrics, which overlays a financial imperative (Hysong, 2009) on top of the professional imperative to deliver high-quality care.
This resource is intended to support the evidence-based design of physician feedback reporting systems. The focus is on developing and using feedback reports for individual physicians working in medical practices and acute care hospitals. But many of the design elements and engagement strategies discussed can be usefully applied to other clinicians in other health care settings, making it a highly flexible intervention to improve performance (Hysong, 2009; Flottorp, et al., 2010).
The guide is organized into four parts:
- Part One presents the “fundamentals” of physician feedback reports in a question and answer format.
- Part Two lists evidence-based practices on how to design a physician feedback reporting system for maximal impact. The purpose of this section is to identify the factors empirically associated with success so that future reports can be most effective. Go to Text Box 1 for a summary of methods used to identify best practices.
Text Box 1. Summary of methods
| The primary source of evidence is the 2012 Cochrane Review on Audit and Feedback: Effects on Professional Practice and Healthcare Outcomes, which identifies a limited number of evidence-based practices from a review of randomized trials (Ivers, et al., 2012). Because the evidence base on how best to design physician feedback reports is still developing, authors supplemented the Cochrane Review findings with additional evidence, including tips from report developers and users. The resulting two categories of guidance—one based on rigorous outcome evaluations and the other based on experiential data—are clearly labeled and distinguished. A formative draft of this guide was reviewed by a multidisciplinary panel that included research experts and physicians and other practitioners engaged in performance improvement. |
- Part Three discusses three strategies available to developers of physician feedback reports to support continuous improvement of their reporting systems.
- Part Four reviews research priorities needed to collectively advance the science of confidential feedback reporting. They derive in part from a panel discussion at the 2015 AHRQ Research Conference (De La Mare, et al., 2015).
