Dissertation (Masters) Completing the Feedback Loop: An Assessment of the Implementation of an Early Stage Audit and Feedback Intervention in Primary Care


Daniel Jonathan Wagner


Audit and Feedback (A&F) is a common quality improvement strategy characterized as an feedback loop enabling an iterative, self-regulating progress. The objective of this thesis was to evaluate the implementation of a specific A&F program in team-based primary care practices. Eighteen semi-structured interviews were conducted to explore its implementation and factors influencing participation. Interview transcripts were analyzed deductively with the support of the Consolidated Framework for Implementation Research. Findings revealed that implementation was not representative of a complete feedback loop. Participation was primarily associated with a perception that the program would develop into a best-in-class A&F initiative for primary care. The relationship between physicians and organizational administrators was identified as a key factor which may support or deter implementation. The study also identified factors related to the design and delivery of A&F that may explain why and how an A&F intervention in primary care can achieve its objectives.