title: The Reasons behind the (Non)Use of Feedback Reports for Quality Improvement in Physical Therapy: A Mixed-Method Study.
abstract: OBJECTIVE
  To explain the use of feedback reports for quality improvements by the reasons to participate in quality measuring projects and to identify barriers and facilitators.
  
  
  METHODS
  Mixed methods design.
  
  
  METHODS
  In 2009-2011 a national audit and feedback system for physical therapy (Qualiphy) was initiated in the Netherlands. After each data collection round, an evaluation survey was held amongst its participants. The evaluation survey data was used to explain the use of feedback reports by studying the reasons to participate with Qualiphy with correlation measures and logistic regression. Semi-structured interviews with PTs served to seek confirmation and disentangle barriers and facilitators.
  
  
  RESULTS
  Analysis of 257 surveys (response rate: 42.8%) showed that therapists with only financial reasons were less likely to use feedback reports (OR = 0.24;95%CI = 0.11-0.52) compared to therapists with a mixture of reasons. PTs in 2009 and 2010 were more likely to use the feedback reports for quality improvement than PTs in 2011 (OR = 2.41;95%CI = 1.25-4.64 respectively OR = 3.28;95%CI = 1.51-7.10). Changing circumstances in 2011, i.e. using EHRs and financial incentives, had a negative effect on the use of feedback reports (OR = 0.40, 95%CI = 0.20-0.78). Interviews with 12 physical therapists showed that feedback reports could serve as a tool to support and structure quality improvement plans. Barriers were distrust and perceived self-reporting bias on indicator scores.
  
  
  CONCLUSIONS
  Implementing financial incentives that are not well-specified and well-targeted can have an adverse effect on using feedback reports to improve quality of care. Distrust is a major barrier to implementing quality systems.
authors: Scientific Institute for Quality of Healthcare Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Marijn
authors: M
authors: Scholte
authors: ROS Caransscoop, Beekbergen, The Netherlands.
authors: Catherina W M
authors: CW
authors: Neeleman-van der Steen
authors: Scientific Institute for Quality of Healthcare Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Philip J
authors: PJ
authors: van der Wees
authors: Scientific Institute for Quality of Healthcare Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Maria W G
authors: MW
authors: Nijhuis-van der Sanden
authors: Scientific Institute for Quality of Healthcare Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Jozé
authors: J
authors: Braspenning
mesh_terms: D000328:Adult; D054869:Clinical Audit; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D026741:Physical Therapy Modalities / Q000592:standards; D058996:Quality Improvement; D012044:Regression Analysis; D011795:Surveys and Questionnaires