Grant: Operating Grant

There remains a large gap between ideal and actual care provided to patients who are at high risk of cardiovascular disease in primary care, such as those with diabetes or with known heart disease. Performance feedback reports are often used when trying to influence the way that care is delivered by clinicians. While there is evidence that feedback reports can be effective, the best way to design and deliver feedback reports to family physicians to improve quality of care is uncertain. This research study aims to determine how feedback reports can be best used to improve quality of care provided by family physicians to patients at high risk of cardiovascular disease. We have developed mechanisms for using a new electronic medical record database to produce feedback reports for family physicians. All participating family physicians will receive feedback reports, but half of the participating primary care clinics have been randomly selected to receive an additional "worksheet". We used evidence from psychology, education, and industrial behaviour to develop this one-page worksheet that will encourage recipients to set goals and develop action plans in response to the feedback reports. After two years, the groups will be compared; we believe that when family physicians develop goals and action plans in response to feedback reports, they will provide better management of cardiovascular risk for their patients with diabetes and/or heart disease. In addition, we will interview a sample of the participants to determine how the feedback design may be improved and to explore barriers and facilitators to the acceptance and utilization of performance feedback by family physicians. We believe that this project will lead to improved quality of care for the nearly 5000 patients in the participating physicians' practices who have diabetes or heart disease, but also that the lessons results will be broadly applicable to quality improvement projects in primary care.