Unpacking the Black Box of Improvement: Performance Feedback Orientation Among Physicians.

Audit and Feedback (A&F) is a widely utilized and promising solution to reduce unwarranted physician-level variation in care, yet its impact is variable in practice and uptake is often suboptimal. While recipient characteristics are acknowledged as an important driver of interaction with A&F reports, surprisingly little attention has been paid to understanding these characteristics and their mechanisms of action. From a control-value perspective, we developed and tested an integrated theoretical model delineating the modifiable antecedents to engaging with A&F by measuring recipient attitudes, beliefs, and regulatory focus in the healthcare context. By using a partial least squares path modeling technique, we found that 1) recipients' commitment to act on feedback is influenced by both their perceived value of and perceived confidence in acting on feedback; 2) both pathways of influence are mediated by perceived usefulness of feedback; 3) recipients' perceived need for change influences their perceived value of acting on feedback; and 4) prevention focus has a negative but insignificant association with perceived usefulness of feedback. Our findings contribute to a more in-depth understanding of the upstream cognitive appraisal process of A&F, which determines recipients' intention to interact with A&F. [ABSTRACT FROM AUTHOR]