Multicomponent audit and feedback for colonoscopy quality improvement among potentially lower-performing endoscopists

Background and Study Aims Multicomponent audit and feedback (A&F) initiatives pair performance reports with education to improve quality. A&F is most effective for those with greatest room for improvement, but effects depend on engagement with A&F. The study objectives were to (1) determine the proportion of potentially lower-performing endoscopists who participated in a voluntary multicomponent A&F initiative, (2) identify barriers and facilitators to endoscopist participation, and (3) describe the actions taken by endoscopists after exposure to this initiative. Participants and Methods We conducted an explanatory sequential mixed methods study. All potentially lower-performing endoscopists practicing in Ontario in 2015 were invited to participate in a voluntary multicomponent A&F initiative; participation rates were tracked. Subsequently, endoscopists were invited to an interview to share their experience with the A&F initiative. Interviews were transcribed. Data were analyzed using directed and conventional content analyses. Results We identified 121 potentially lower-performing endoscopists among the 885 practicing in Ontario in 2015. Only 25 endoscopists (20.7%) participated in the A&F initiative. Eleven of 121 endoscopists completed the interview. Interviewees discussed 18 facilitators and 11 barriers to participation in the A&F initiative. Some interviewees took steps to improve their colonoscopy quality, changed documentation practices to improve the accuracy of future A&F reports, or adopted potentially inappropriate documentation or patient care practices to look better on future A&F reports. Conclusions The low participation rate, the range of drivers of endoscopist participation, and the intended and unintended effects identified suggest that A&F initiatives are complex interventions requiring careful design and evaluation.