Improving quality of care. A systematic review on how medical registries provide information feedback to health care providers.

OBJECTIVE

To determine (1) how medical registries provide information feedback to health care professionals, (2) whether this feedback has any effect on the quality of care and (3) what the barriers and success factors are to the effectiveness of feedback.

DATA SOURCES

Original articles in English found in MEDLINE Pubmed covering the period January 1990 to August 2007.

REVIEW METHOD

Titles and abstracts of 6223 original articles were independently screened by two reviewers to determine relevance for further review.

DATA EXTRACTION AND ANALYSIS

We used a standardized data abstraction form to collect information on the feedback initiatives and their effectiveness. The effect of the feedback was only described for analytic papers, i.e. papers that attempted to objectively quantify the effect on the quality of care and to relate this effect to feedback as an intervention. For analysis of the effectiveness, we categorized the initiatives based on the number of elements added to the feedback.

RESULTS

We included 53 papers, describing 50 feedback initiatives, of which 39 were part of a multifaceted approach. Our results confirm previous research findings that adding elements to a feedback strategy positively influences its effectiveness. We found 22 analytic studies, four of which found a positive effect on all outcome measures, eight found a mix of positive- and no effects and ten did not find any effects (neither positive nor negative). Of the 43 process of care measures evaluated in the analytic studies, 26 were positively affected by the feedback initiative. Of the 36 evaluated outcome of care measures, five were positively affected. The most frequently mentioned factors influencing the effectiveness of the feedback were: (trust in) quality of the data, motivation of the recipients, organizational factors and outcome expectancy of the feedback recipients.

CONCLUSIONS

The literature on methods and effects of information feedback by medical registries is heterogeneous, making it difficult to draw definite conclusions on its effectiveness. However, the positive effects cannot be discarded. Although our review confirms findings from previous studies that process of care measures are more positively influenced by feedback than outcome of care measures, further research should attempt to identify outcome of care measures that are sensitive to behaviour change as a result of feedback strategies. Furthermore, future studies evaluating the effectiveness of feedback should include a more extensive description of their intervention in order to increase the reproducibility of feedback initiatives and the generalizability of the results.