Table 1

Participating implementation laboratories in the A&F MetaLab

LaboratoryHealth system partnerA&F interventions testedEvaluation design
AFFINITIE—enhanced A&F interventions to increase the uptake of evidence-based transfusion practiceNational 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 DashboardBetter 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 unitsNICE 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 homesHealth Quality Ontario, Canada
  • Variation in comparators featured in the feedback reports (eg, overall provincial average prescribing rate versus the 25th 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 SettingNHS 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.