Table 1

Participating implementation laboratories in the A&F MetaLab

Laboratory	Health system partner	A&F interventions tested	Evaluation design
AFFINITIE—enhanced A&F interventions to increase the uptake of evidence-based transfusion practice	National Comparative Audit of Blood Transfusion, UK	Enhanced feedback report content (eg, streamlining formatting, highlighting gaps between current and recommended practice, and suggesting practical action plans) Enhanced ‘follow on’ support for local action (ie, a web-based toolkit for use by hospital transfusion teams and telephone support to increase engagement)	Two linked and sequential cluster randomised 2×2 factorial trials with parallel process and economic evaluations 147 and 137 hospitals
BORN MND—Better Outcomes Registry & Network Ontario- Maternal Newborn Dashboard	Better Outcomes Registry & Network, Ontario, Canada	A&F provided via the MND which consists of near real-time hospital-specific feedback about six key performance indicators, peer comparison data, a visual display of practice gaps and benchmarks to provide direction for practice change Evidence summaries are also provided for each of the key performance indicators.	Mixed methods: Interrupted time series analysis using population-based data from all maternal newborn hospitals in Ontario covering a 3- year period before implementation of the MND and 2.5 years after Provincial survey of all hospitals and site visits with a diverse sample of hospitals to identify barriers and facilitators to use of the MND and determine factors that influence uptake to trigger and facilitate practice change 96 hospitals
Implementing Goals of Care Conversations with Veterans in Veteran Affairs (VA) Long Term Care Settings Health system partner:	VA Corporate Data Warehouse; VA National Centre for Ethics in Healthcare, USA	Electronically generated feedback reports providing feedback on performance in documenting goals of care conversations, coupled with learning collaboratives Different formats and delivery of feedback reports will be tested	Quasi-experimental mixed-methods design using interrupted time series
NICE foundation electronic quality dashboard with action implementation toolbox to enhance quality of pain management in Dutch intensive care units	NICE quality registry, the Netherlands	Online quality dashboard Intervention group additionally receives access to an integrated action implementation toolbox of suggested actions and materials to further support the development and management of action plans	Two-arm cluster randomised controlled trial with the same 21 ICUs allocated to feedback without or feedback with action implementation toolbox group Both arms receive telephone support to increase engagement 21 intensive care units; 72 individual professionals
OHIL—Ontario Healthcare Implementation Laboratory: Improving the impact of Practice Reports in nursing homes	Health Quality Ontario, Canada	Variation in comparators featured in the feedback reports (eg, overall provincial average prescribing rate versus the 25^th percentile prescribing rate) Variation in the framing of the content as positive or negative (eg, recipients may be told they have prescribed potentially harmful medications to 15% of their patients versus avoiding prescription-related harms in 85% of their patients)	Cluster randomised 2×2 factorial trial with embedded mixed-method process evaluation Prescribers receive three iterations of the report Prescribers receive surveys and may also participate in interviews to assess mechanism of action and additional barriers to use of reports to make changes
TRIADS—Translation Research in a Dental Setting	NHS Education Scotland	Enhanced feedback report content (eg, changing comparators) Enhanced persuasive messaging using behaviour change techniques Timing of feedback Impact of educational outreach visits in addition to audit Enhanced audits using behaviour taxonomy approaches	Cluster randomised (sometimes factorial trials) are conducted whenever possible Time series are also used to monitor impact of national audits.

A&F, audit and feedback; ICUs, intensive care units; MND, Maternal Newborn Dashboard; NHS, National Health Service; NICE, National Intensive Care Evaluation.