Table 5 Meta-Synthesis Matrix: Integrating Feedback Reporting Approaches and Co-Interventions to Enhance Effectiveness

Feedback Delivery

CP-FIT best practices to report feedback

 • Timely Feedback

Studies testing timely feedback ranging from weekly to monthly reports reported positive improvements compared to feedback reported less frequently

Delays between patient reviews and engagement hindered ownership and monitoring

Feedback delivered on timely and frequent intervals keep HCPs engaged and take ownership of quality improvement interventions

 • Feedback specific to HCPs’ care delivery

Group feedback caused ambiguity about individual vs. team performance

Individualized feedback is clearer and more actionable

 • Peer Comparisons

Peer comparisons prompted reflection, but lack of peer discussion reduced guidance

Peer comparisons are usually included with feedback data and facilitate comprehension. Group-facilitated discussion further enhance impact of feedback

 • Feedback with user-friendly designs

Clear formats (e.g., dashboards, Venn diagrams) enhanced usability; overly complex designs hindered interpretation. valuable insights into personal practice variations

Feedback should use simple charts and graphs, with concise text to complement more complex visualizations

Types of Quality Indicators

 • Process Measures

85% studies reported improvements in clinical procedures and assessments, prescribing behaviours)

Process indicators tied to clinician actions drive better outcomes

 • Outcome Measures/ and process measures

68% studies showed improvements, particularly in clinician-reported outcomes

Combining process and outcome measures enhances impact and relevance over using outcome measures alone

 • Data characteristics

Meaningful data tied to HCP control improved feedback acceptance

Data Security: Public sharing without improvement time was seen as punitive; secure email delivery was preferred

Data Validity: Concerns over coding accuracy and validity reduced trust

Patient Background: Missing baseline patient information hindered interpretation

Relevant, valid, and contextual data, delivered securely and confidentially, enhances feedback trust, acceptance, and clarity

Types of Co-interventions applied with feedback intervention

Facilitative approaches (e.g., education, reminders, post-feedback consultations) improved outcomes

Coercive approaches: Structural modifications e.g., action toolboxes, supported practice changes; coercive methods (e.g., financial incentives) were less effective

Structural changes and evidence-based practice support were well-received, with training by feedback champions or peers valued

Facilitative approaches and structural supports are preferred; coercive methods such as financial incentives have less impact

Other factors influencing feedback intervention

Perceived accountability enhanced engagement with feedback

Limited knowledge and skills for interpreting data impeded interaction with data and performance

External factors, such as patient demands for specific drugs or services, influenced HCP decision-making, while involvement of insurers and other stakeholders with conflicting objectives discouraged acceptance of feedback

To enhance feedback engagement, emphasize strategies that promote accountability, provide targeted training to improve data interpretation skills, and address external influences by aligning stakeholder goals and managing patient expectations effectively