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

Harrison, Reema, Hinchcliff, Reece Amr, Manias, Elizabeth, Mears, Steven, Heslop, David, Walton, Victoria and Kwedza, Ru 2020, Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis, BMC health services research, vol. 20, pp. 1-18, doi: 10.1186/s12913-019-4860-0.

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Title Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis
Author(s) Harrison, Reema
Hinchcliff, Reece Amr
Manias, ElizabethORCID iD for Manias, Elizabeth orcid.org/0000-0002-3747-0087
Mears, Steven
Heslop, David
Walton, Victoria
Kwedza, Ru
Journal name BMC health services research
Volume number 20
Article ID 40
Start page 1
End page 18
Total pages 18
Publisher BMC
Place of publication London, Eng.
Publication date 2020-01
ISSN 1472-6963
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Unwarranted clinical variation
Clinical variation
Health services
Facilitated feedback
Clinician feedback
Effective care
QUALITY-OF-CARE
PERFORMANCE INDICATORS
DECISION-SUPPORT
IMPROVEMENT
IMPACT
APPROPRIATENESS
COLLABORATION
INTERVENTIONS
INCREASE
REVIEWS
Summary BACKGROUND: Assessment of clinical variation has attracted increasing interest in health systems internationally due to growing awareness about better value and appropriate health care as a mechanism for enhancing efficient, effective and timely care. Feedback using administrative databases to provide benchmarking data has been utilised in several countries to explore clinical care variation and to enhance guideline adherent care. Whilst methods for detecting variation are well-established, methods for determining variation that is unwarranted and addressing this are strongly debated. This study aimed to synthesize published evidence of the use of feedback approaches to address unwarranted clinical variation (UCV). METHODS: A rapid review and narrative evidence synthesis was undertaken as a policy-focused review to understand how feedback approaches have been applied to address UCV specifically. Key words, synonyms and subject headings were used to search the major electronic databases Medline and PubMed between 2000 and 2018. Titles and abstracts of publications were screened by two reviewers and independently checked by a third reviewer. Full text articles were screened against the eligibility criteria. Key findings were extracted and integrated in a narrative synthesis. RESULTS: Feedback approaches that occurred over a duration of 1 month to 9 years to address clinical variation emerged from 27 publications with quantitative (20), theoretical/conceptual/descriptive work (4) and mixed or multi-method studies (3). Approaches ranged from presenting evidence to individuals, teams and organisations, to providing facilitated tailored feedback supported by a process of ongoing dialogue to enable change. Feedback approaches identified primarily focused on changing clinician decision-making and behaviour. Providing feedback to clinicians was identified, in a range of a settings, as associated with changes in variation such as reducing overuse of tests and treatments, reducing variations in optimal patient clinical outcomes and increasing guideline or protocol adherence. CONCLUSIONS: The review findings suggest value in the use of feedback approaches to respond to clinical variation and understand when action is warranted. Evaluation of the effectiveness of particular feedback approaches is now required to determine if there is an optimal approach to create change where needed.
Language eng
DOI 10.1186/s12913-019-4860-0
Indigenous content off
Field of Research 1117 Public Health and Health Services
0807 Library and Information Studies
HERDC Research category C1 Refereed article in a scholarly journal
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30133853

Document type: Journal Article
Collections: Faculty of Health
School of Nursing and Midwifery
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.