Journal of Continuing Education in the Health Professions (07/06/22) Roy, Marguerite; Lockyer, Jocelyn; Touchie, Claire

Researchers used realist methods to investigate the relationships between outcomes, mechanisms and context factors underlying a national multisource feedback (MSF) program. The authors analyzed linked data for 50 family physicians to ascertain how action plan completion status related to MSF ratings, MSF comments and prescribing data, summarized facilitator-physician dialogue and practice risk factors. Similarities and distinctions in mechanisms and context were traced backward from the outcomes. The results indicated that engagement between resource and reasoning mechanisms and context mediating the relationships affected the plans' completion status. Physicians who deployed all of their plans within six months had consistent feedback, reviewed data prior to facilitation, co-developed plans with facilitators and had less risk of dyscompetence. Participants who failed to implement any plans saw data with fewer recurring messages, did not merge these into plans, encountered difficulty, or had to engage others and were physician-directed, and were more vulnerable to dyscompetence. "Evaluation of quality improvement initiatives should examine program outcomes taking into consideration the interplay of resources, reasoning, and risk factors for dyscompetence," the authors advise.

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