Peer Comparison Research Articles

Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery.

Surgeons play a pivotal role in combating the opioid crisis that currently grips the United States. Changing surgeon behavior is difficult, and the degree to which behavioral science can steer surgeons toward decreased opioid prescribing is unclear. This was a single-institution, single-arm, pre- and postintervention study examining the prescribing of opioids by urologists for adult patients undergoing prostatectomy or nephrectomy. The primary outcome was the quantity of opioids prescribed in oral morphine equivalents (OMEs) after hospital discharge. The primary exposure was a multipronged behavioral intervention designed to decrease opioid prescribing. The intervention had 3 components: 1) formal education, 2) individual audit feedback, and 3) peer comparison performance feedback. There were 3 phases to the study: a pre-intervention phase, an intervention phase, and a washout phase. Three hundred eighty-two patients underwent prostatectomy, and 306 patients underwent nephrectomy. The median OMEs decreased from 195 to 19 in the prostatectomy patients and from 200 to 0 in the nephrectomy patients (P < .05 for both). The median OMEs prescribed did not increase during the washout phase. Prostatectomy patients discharged with opioids had higher levels of anxiety than patients discharged without opioids (P < .05). Otherwise, prostatectomy and nephrectomy patients discharged with and without opioids did not differ in their perception of postoperative pain management, activity levels, psychiatric symptoms, or somatic symptoms (P > .05 for all). Implementing a multipronged behavioral intervention significantly reduced opioid prescribing for patients undergoing prostatectomy or nephrectomy without compromising patient-reported outcomes.

A comparison of peer and faculty narrative feedback on medical student oral research presentations.

ObjectivesThe purpose of this project was to evaluate and improve the oral presentation assessment component of a required research training curriculum at an undergraduate medical school by analyzing the quantity, quality, and variety of peer and faculty feedback on medical student oral research presentations. MethodsWe conducted a program evaluation of oral presentation assessments during the 2016 and 2017 academic years. Second-year medical students (n=225) provided oral presentations of their research and received narrative feedback from peers and faculty. All comments were inductively coded for themes and Chi-square testing compared faculty and peer feedback differences in quantity, quality, and variety, as well as changes in feedback between the initial and final presentations. Comparative analysis of student PowerPoint presentation files before and after receiving feedback was also conducted. ResultsOver two years, 2,617 peer and 498 faculty comments were collected and categorized into ten themes, with the top three being: presentation skills, visual presentation, and content. Both peers and judges favored providing positive over improvement comments, with peers tending to give richer feedback, but judges more diverse feedback. Nearly all presenters made some change from the initial to final presentations based on feedback. ConclusionsData from this analysis was used to restructure the oral presentation requirement for the students. Both peer and faculty formative feedback can contribute to developing medical student competence in providing feedback and delivering oral presentations. Future studies could assess student perceptions of this assessment to determine its value in developing communication skills.

What Causes Heterogeneous Responses to Social Comparison Messages for Water Conservation?

Social comparisons for water conservation are often implemented in conjunction with a broader set of drought management policies. We investigate the interaction of social comparisons with prior responses to voluntary appeals for water conservation using a large-scale field experiment in Reno, Nevada. We develop a new social comparison framed as performance toward a conservation goal in contrast to the traditional comparison made in gallons. Our new social comparison decouples the performance relative to the peer group from baseline water use, allowing us to investigate the role of the peer comparison independently from baseline water use. Using a traditional and our new social comparison, we investigate prior conservation and baseline water use as drivers of heterogeneous response to social comparisons. Baseline water drives treatment heterogeneity in the traditional social comparison, while prior conservation drives treatment heterogeneity the new social comparison. The results indicate that under-performance relative one’s peers is critical for generating water conservation. Simple targeting of both types of social comparisons can increase aggregate savings by 38% because our new social comparison generates conservation among a different set of households compared to the traditional social comparison.

Reducing Imaging Utilization in Primary Care Through Implementation of a Peer Comparison Dashboard.

High clinical variation has been linked to decreased quality of care, increased costs, and decreased patient satisfaction. We present the implementation and analysis of a peer comparison intervention to reduce clinical variation within a large primary care network. Evaluate existing variation in radiology ordering within a primary care network and determine whether peer comparison feedback reduces variation or changes practice patterns. Radiology ordering data was analyzed to evaluate baseline variation in imaging rates. A utilization dashboard was shared monthly with providers for a year, and imaging rates pre- and post-intervention were retrospectively analyzed. Providers within the primary care network spanning 1,358,644 outpatient encounters and 159 providers over a 3-year period. The inclusion of radiology utilization data as part of a provider's monthly quality and productivity dashboards. This information allows providers to compare their practice patterns with those of their colleagues. We measured provider imaging rates, stratified by modality, as well as order variation over time. We observed significant variation in imaging rates among providers in the network, with the top decile ordering an average of 4.2 times more than the lowest decile in the two years prior to intervention. Provider experience and training were not significantly associated with imaging utilization. In the first year after sharing utilization data with providers, we saw a 17.3% decrease in median imaging rate (p < 0.001) and a 21.4% reduction in provider variation between top and bottom deciles. Median ordering rate for more costly cross-sectional imaging, including CT, MRI, and nuclear medicine studies, decreased by 30.4% (p < 0.001), 20.2% (p = 0.008), and 41.8% (p = 0.002), respectively. Peer comparison feedback can shape provider imaging behavior even in the absence of targets or financial incentives. Peer comparison is a low-touch, low-cost intervention for influencing provider ordering and may have applicability in other clinical areas.

How to Keep Diffusion of Responsibility From Undermining Value-Based Care.

Diffusion of responsibility describes how individuals can underperform in circumstances of shared accountability. While not well studied in health care settings, this phenomenon is an unintended consequence of the health care sector's complexity and fragmentation. This article considers 3 ways in which monetary and nonmonetary incentives can mitigate negative consequences of diffusion of responsibility. First, incentives should be finite and focused. Second, health care organizations can incentivize both individual and team performance. Third, organizations can use peer comparison feedback to amplify effective incentivizing strategies.

Papanicolaou Staining and Processing Troubleshooting Exercise Using Digital Pathology: Peer Comparison in an External Quality Assurance Setting

Background: The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) offers a comprehensive range of External Quality Assurance programs for all disciplines of pathology and is committed to delivering programs to advance outcomes in patient care and promote excellence in laboratory diagnostic and technical proficiency. Proficiency testing in cytopreparatory techniques became available for formal enrolment in 2018. The 2019 technical program focused on the demonstration of a laboratory to troubleshoot problems encountered during staining and processing. The exercise provided a peer comparison of a laboratory’s ability to (1) identify the problem viewed from a digital image and (2) describe the troubleshooting steps to rectify the problem using assessment guidelines. Methods: Ten troubleshooting exercises including whole-slide z-stacked virtual images, a reference slide, and an online Result Entry questionnaire were provided. Common staining and processing problems were demonstrated in these exercises. Multiple-choice responses were made available to participants for each case with 1 response requiring submission. Participants were then allowed free text to describe how they would rectify the problem. Results: Of the 72 participants who participated, 62 participants (86%) achieved a satisfactory assessment, 6 participants (8%) received a borderline assessment, and 4 participants (6%) received an unsatisfactory assessment. The average mark obtained was 32.7 out of a total of 45 marks, which equates to a satisfactory assessment. The highest mark obtained for this survey was 42.5. Conclusions: Quality cytopathology preparatory techniques are integral to mitigating the risk of diagnostic error. The digital pathology platform allowed homogeneity of samples for all participants and appeared to be a satisfactory mode for demonstrating the technical problems to participants. Laboratories participating in this survey showed good performance in identifying processing and staining problems on virtual images and working through the troubleshooting steps. The exercise also identified a method for troubleshooting formalin vapour-affected slides using citrate buffer which may be useful for laboratories following in-house validation.

CEO Pay and the Argument from Peer Comparison

Chief executive officers (CEOs) are typically paid great amounts of money in wages and bonuses by commercial companies. This is sometimes defended with an argument from peer comparison; roughly that “our” CEO has to be paid in accordance with what other CEOs at comparable companies get. At first glance this seems like a poor excuse for morally outrageous pay schemes and, consequently, the argument has been ignored in the previous philosophical literature. In contrast, however, this article provides a partial defence of the argument from peer comparison. Moreover, it is demonstrated how a serious consideration of this argument sheds further light on both incentive- and desert-based theories of just pay.

The Accuracy of Peer Comparison Observations: A Simulated Analysis

Classroom observations are frequently conducted with the purpose of comparing the behavior of a target student to that of other peers within the same classroom. A variety of procedures may be utilized by researchers and practitioners to collect such data; however, little is known of the accuracy of estimates of behavior produced by such procedures relative to continuous behavior recording for the target student, peers sampled as a representation of the class, and the class as a whole. The purpose of the present study was to evaluate the accuracy of estimates of frequently utilized peer comparison observation procedures relative to duration recording. Data were simulated for 4,000 classroom observations, with variations in level of classroom behavior and length of observation being simulated. Results indicated that an Every Fifth interval procedure resulted in the lowest levels of absolute error during single observations for target students, with planned activity checks resulting in the most accurate estimates of class-wide behavior. Despite differences being apparent in level of accuracy of single observations, differences in accuracy across procedures were not apparent when all observations of the same type (i.e., duration, level of classroom behavior, and observation procedure) were compared.

Physician Practices and the Late Adoption of Transparent Peer Comparisons for Performance Feedback

Research ObjectiveOver the past two decades, health care organizations have recognized the importance of physician feedback and data transparency for continuous performance improvement. Diffusion of innovation theory suggests that late‐adopting organizations face unique barriers to adoption, particularly of innovations that require infrastructure investments. This study aims to identify qualities associated with physician practices’ late or non‐adoption of unblinded peer comparisons for performance reporting.Study DesignThis research draws on the cross‐sectional 2017/2018 National Survey of Healthcare Organizations and Systems (NSHOS) practice‐level survey (response rate=47%) linked to 2017 IQVIA OneKey data on physician practices. Predictors of unblinded performance feedback include composites of organizational learning orientation, organizational capacity for innovation, health information technology (HIT capabilities), and participation in delivery reform initiatives. We perform a logistic regression to estimate the odds that a practice does not report using unblinded peer comparison feedback, controlling for reported practice ownership, a measure of physician influence on practice priorities and strategies, Medicaid revenue (less than 30% or ≥30%, as a proxy for financial resources and patient complexity), and practice size (physician count).Population StudiedWe study the population of practices with at least three primary care physicians using a nationally representative sample of 2,190 non‐federal physician practices. Practices are of diverse ownership, including primary care and multispecialty provider groups, those owned by healthcare systems, independent practices, and other arrangements.Principal Findings27% of physician practices did not report using unblinded peer comparisons for performance feedback reports. These physician practices had lower organizational learning orientation (OR=0.689, p&lt;0.001), lower HIT capabilities (OR = 0.725, P &lt; .001), and less participation in delivery reform initiatives (OR = 0.740, P &lt; .001). No significant association was found between organizational capacity for innovation and late adopter status. Of control variables, health care system ownership or ownership by some other entity, and “some” physician influence (compared to “little to none” or “a lot”) were found to be significantly associated with practice use of transparent performance comparisons. Our Medicaid revenue variable was not found to be significant.ConclusionsPhysician practices that do not use unblinded peer comparisons for performance feedback have lower organizational learning orientations, lower HIT capabilities, and participate in fewer delivery reform initiatives than adopters of transparent reporting. These findings indicate that late or non‐adopting practices may be less motivated toward learning, and external quality incentives may be less important influences on their innovation adoption. HIT capabilities and economies of scale related to practice ownership may also improve adoption of transparent performance reporting.Implications for Policy or PracticePhysician practices which have not adopted transparent performance reporting have lower orientation to organizational learning, lag in their expansion of HIT capabilities, and participate in fewer reform initiatives. This suggests that policies and programs which encourage performance transparency, such as Medicare’s Quality Payment Program, should be attentive to the resource needs and infrastructure considerations of late or non‐adopters.Primary Funding SourceAgency for Healthcare Research and Quality.

Two to Tango? Psychological Contract Breach on Online Labor Markets

Despite some advantages over traditional (offline) labor markets – such as lower search costs, better matching and improved monitoring – online labor markets (OLMs) have not taken off as initially expected. In this paper, we study the factors that limit perceived project success on OLMs. Using psychological contract theory, we theorize how common OLM features including contracts with virtual monitoring, multi-freelancer projects, and simultaneous projects by a client trigger the perception of psychological contract breach among OLM participants and reduce perceived project success for both participants. We test these hypotheses using an extensive dataset with more than 143,000 transactions on the world’s largest freelancing platform, Upwork, and find that – contrary to predictions from agency theory – projects equipped with strict freelancer monitoring (hourly-pay contracts) and projects enabling peer comparison (multi-freelancer projects or multiple simultaneous projects), lead to lower perceived project success both from the freelancer’s and the client’s perspective. Our work implies that transactions on online labor markets should not be viewed solely as agency relations, and that some features that supposedly reduce agency costs and improve efficiency on OLMs come at the cost of triggering the perception of psychological contract breach.

Motivating non-ratepaying households with feedback and social nudges: A cautionary tale

Behavioral interventions have been shown to be valuable instruments in reducing energy use among ratepaying customers, but their effect on non-ratepayers has received less attention. This study uses a randomized controlled trial research design to examine the effect of feedback and a social nudge in the form of peer comparison on energy consumption of non-ratepaying households. The study setting is a university family housing complex, and findings are based on hourly observations of energy use by 62 households over thirteen weeks. Our results suggest that neither feedback or peer comparison is an effective instrument to reduce energy use of non-ratepaying households, and may even increase energy consumption in some contexts. We find heterogeneous effects among households that are low and high users of energy in the pre-treatment period, with high users increasing energy consumption in response to feedback. Thus, caution is needed in applying behavioral interventions when financial incentives to reinforce intended effects are absent.

Thematic Examination of Postgraduate Studies in Comparison of Peers of Gifted Students with Their Peers

Bu araştırmanın amacı üstün yetenekliler alanında yapılan çalışmalardan üstün yetenekli tanısı almış öğrencilerin akranlarıyla karşılaştırıldığı lisansüstü çalışmaların tematik olarak incelenmesidir. Araştırmada YÖK (Ulusal Tez Merkezi) veri tabanında kayıtlı ve 1995-2019 yılları arasında hazırlanmış olan lisansüstü çalışmalar incelenmiştir. Bu araştırmada kriterlere uygun olan 5 doktora ve 40 yüksek lisans tezi incelenmiştir. Araştırmada nitel araştırma yöntemlerinden belge/doküman incelemesi tekniği kullanılmıştır. Araştırmanın verileri içerik analizi tekniği kullanılarak gerçekleştirilmiştir. Lisansüstü çalışmaların düzeyleri, hangi yıllarda yapıldıkları, yöntemleri, konuları, üniversiteleri, tez danışman unvanları, izin durumları ve sonuçları gibi bilgiler araştırmanın bulgularını oluşturmaktadır. Araştırma sonuçlarına göre, lisansüstü çalışmaların genellikle eğitim alanında yapıldığı, yöntem olarak genelde nicel araştırma yönteminin benimsendiği, düzeylerinin ise yüksek oranda yüksek lisans olduğu ve 2005 yılından sonra önemli bir artış gösterdiği tespit edilmiştir. Araştırma sonucunda elde edilen veriler ışığında üstün yetenekliler konusunun eğitim, psikoloji dışında da farklı alanlar tarafından çalışılmaya başlanması, üstün yetenekli öğrencilerin akranları ile karşılaştırıldıkları lisansüstü çalışmalarda doktora düzeyinde çalışmaların artırılması, üstün yetenekli öğrencilerin akranları ile karşılaştırıldıkları lisansüstü çalışmalarda karma yöntemlerin daha çok kullanılması önerileri getirilmektedir.

Evidências preliminares de talento musical em crianças na educação básica

O talento musical pode se manifestar em diferentes pessoas, em diferentes realidades sociais e econômicas e fases da vida. A legislação prevê a identificação, cadastramento e atendimento educacional especializado ao talentoso musical. Assim, o objetivo da pesquisa foi construir um instrumento para realização de screening em alunos de escolas da educação básica. Para isso, valeu-se do método psicofísico de comparação por pares, por meio de pesquisa de campo. A análise dos dados pautou-se na estatística não-paramétrica e análise fatorial exploratória. Concluiu-se que houve indicativos da capacidade de mensuração do instrumento, porém será preciso continuar os procedimentos de validação e fidedignidade.

Utilizing Behavioral Science to Improve Antibiotic Prescribing in Rural Urgent Care Settings.

BackgroundAntibiotic-inappropriate prescribing for acute respiratory tract infections (ARTI) is 45% among urgent care centers (UCCs) in the United States. Locally in our UCCs, antibiotic-inappropriate prescribing for ARTI is higher—over 70%.MethodsWe used a quasi-experimental design to implement 3 behavioral interventions targeting antibiotic-inappropriate/non-guideline-concordant prescribing for ARTI at 3 high-volume rural UCCs and analyzed prescribing rates pre- and post-intervention. The 3 interventions were (1) staff/patient education, (2) public commitment, and (3) peer comparison. For peer comparison, providers were sent feedback emails with their prescribing data during the intervention period and a blinded ranking email comparing them with their peers. Providers were categorized as “low prescribers” (ie, ≤23% antibiotic-inappropriate prescriptions based off the US National Action Plan for Combating Antibiotic Resistant Bacteria 2020 goal) or “high prescribers” (ie, ≥45%—the national average of antibiotic-inappropriate prescribing for ARTI). An interrupted time series (ITS) analysis compared prescribing for ARTI (the primary outcome) over a 16-month period before the intervention and during the 6-month intervention period, for a total of 22 months, across the 3 UCCs.ResultsFewer antibiotic-inappropriate prescriptions were written during the intervention period (57.7%) compared with the pre-intervention period (72.6%) in the 3 UCCs, resulting in a 14.9% absolute decrease in percentage of antibiotic-inappropriate prescriptions. The ITS analysis revealed that the rate of antibiotic-inappropriate prescribing was statistically significantly different pre-intervention compared with the intervention period (95% confidence interval, –4.59 to –0.59; P = .014).ConclusionsIn this sample of rural UCCs, we reduced antibiotic-inappropriate prescribing for ARTI using 3 behavioral interventions.

Effect of integrating machine learning mortality estimates with behavioral nudges to increase serious illness conversions among patients with cancer: A stepped-wedge cluster randomized trial.

12002 Background: Most patients with cancer die without a documented serious illness conversation (SIC) about prognosis and goals. Interventions that increase SICs between oncology clinicians and patients may improve goal-concordant care and end-of-life outcomes. Methods: In this stepped-wedge cluster randomized trial (NCT03984773), we tested the effect of an intervention delivering machine learning-based mortality estimates with behavioral nudges to oncologists to increase SICs among patients with cancer. The clinician-focused intervention consisted of 1) weekly emails providing individual SIC performance feedback (number of SICs in the past month) and peer comparisons; 2) a list of patients scheduled for the next week with a ≥10% predicted risk of 6 month mortality by a validated machine learning prognostic algorithm, and 3) automated opt-out text prompts on the patient’s appointment day to consider an SIC. Eight medical oncology clinics were randomized to receive the intervention in a stepped-wedge fashion every four weeks for a total of 16 weeks. Medical oncology clinicians were included if they were trained to use the SIC Guide (Ariadne Labs, Boston MA). Patients were included if they had an outpatient encounter with an eligible clinician between June 17 and November 1, 2019. The primary outcome was the percent of patient encounters with a documented SIC. Intention to treat analyses adjusted for clinic and wedge fixed effects and clustered at the oncologist level. Results: The sample consisted of 78 clinicians and 14,607 patients. The mean age of patients was 61.7 years, 55.7% were female, 70.4% were white, and 19.6% were black. The percent of patient encounters with an SIC was 1.2% (106/8536) during the pre-intervention period and 4.0% (401/10,152) during the intervention period. In intention to treat adjusted analyses, the intervention led to a significant increase in SICs (adjusted odds ratio, 3.7; 95% CI, 2.5 to 5.4, P value &lt; 0.0001). Conclusions: An intervention consisting of machine learning mortality estimates and behavioral nudges to oncology clinicians increased SICs by three-fold over 16 weeks, a significant difference.This is one of the first studies evaluating a machine learning-based behavioral intervention to improve serious illness communication in oncology. Secondary analyses (completed April 2020) will clarify whether this intervention leads to a sustained increase in SIC rates and improves goal-concordant care and end-of-life outcomes. Clinical trial information: NCT03984773 .

A Qualitative Approach to Understanding the Relationship Between Mothers’ and Daughters’ Body Image and Physical Activity Levels

The aim of this study was to explore the physical activity behaviors and body image of adolescent girls and their mothers. Adolescent girls ( N = 44) and their mothers ( N = 19) were recruited from three middle schools (two Colorado and one South Carolina). Girls qualifying for free or reduced-price lunches comprised 53% (South Carolina), 32% (Colorado), and 39% (Colorado) of participants. Focus groups with questions pertaining to body image and physical activity were conducted with daughters and mothers. The study was approved by the first author’s Institutional Review Board. Data were assessed using the five-step framework analysis. A thematic framework was identified, quotes were divided under the thematic content, and results were then interpreted by analyzing links among the whole data set. Four themes and eight subthemes emerged: (1) complex communication, with subthemes of daughter’s frustration and mother’s confusion, (2) societal expectations of women, with subthemes of social networks and women’s bodies, (3) high prevalence of social comparison, with subthemes of mother/daughter comparison and peer comparison, and (4) daughters’ awareness of mother’s health behaviors, with subthemes of weight loss and physical activity. Interventions aimed at improving adolescent girls’ health should include support for mothers as well as a psychosocial health and a mother’s educational component.

A gamification platform to foster energy efficiency in office buildings

Office buildings consume a significant amount of energy that can be reduced through behavioral change. Gamification offers the means to influence the energy consumption related to the activities of the office users. This paper presents a new mobile gamification platform to foster the adoption of energy efficient behaviors in office buildings. The gamification platform is a mobile application with multiple types of dashboards, such as (1) an information dashboard to increase the awareness of the users about their energy consumption and footprint, (2) a gaming dashboard to engage users in real-time energy efficiency competitions, (3) a leaderboard to promote peer competition and comparison, and (4) a message dashboard to send tailor-made messages about energy efficiency opportunities. The engagement and gamification strategies embedded in these dashboards exploit economic, environmental, and social motivations to stimulate office users to adopt energy efficient behaviors without compromising their comfort and autonomy levels. The gamification platform was demonstrated in an office building environment. The results suggest electricity savings of 20%.

Assessing The Effectiveness Of Peer Comparisons As A Way To Improve Health Care Quality.

Policy makers are increasingly using performance feedback that compares physicians to their peers as part of payment policy reforms. However, it is not known whether peer comparisons can improve broad outcomes, beyond changing specific individual behaviors such as reducing inappropriate prescribing of antibiotics. We conducted a cluster-randomized controlled trial with Blue Cross Blue Shield of Hawaii to examine the impact of providing peer comparisons feedback on the quality of care to primary care providers in the setting of a shift from fee-for-service to population-based payment. Over 74,000 patients and eighty-eight primary care providers across sixty-three sites were included over a period of nine months in 2016. Patients in the peer comparisons intervention group experienced a 3.1-percentage-point increase in quality scores compared to the control group-whose members received individual feedback only. This result underscores the effectiveness of peer comparisons as a way to improve health care quality, and it supports Medicare's decisions to provide comparative feedback as part of recently implemented primary care and specialty payment reform programs.

Successive negative contrast in humans: Dissociation between behavioral and affective measures of frustration

Successive negative contrast (SNC) involves a disruption of behavior when the magnitude of a reward is reduced unexpectedly from a large to a small amount, relative to a control always receiving the small amount. In the present study, a cognitive task based on the Raven's Progressive Matrices test was used to induce SNC in humans (college students), analyzing its impact on performance (reaction time, accuracy) and affective state. Training involved two phases for the SNC groups: preshift (80 % probability of receiving post-trial positive feedback) and postshift (20 % probability of receiving post-trial positive feedback); control groups always received low probability of positive feedback (20 %). Reward expectancy (expected score obtained in the task) was manipulated in three experiments involving (a) training under SNC or control conditions (Experiment 1); (b) participants’ estimation of performance before starting the task (high -SNC-, low -control-; Experiment 2); and (c) information about peers showing high (SNC) or low performance (control; Experiment 3). Experiments 1–2 provided evidence of a dissociation between behavioral and affective measures of frustration. Only participants downshifted in magnitude of reward based on peer comparison (Experiment 3) exhibited behavioral impairment accompanied by negative affect after reward devaluation. The results are discussed in terms of differences across experiments in the way the reward expectancy was initially induced and subsequently violated. Contributions and limitations of these studies to analyze how incentive relativity influences behavior and affect are also considered.

MP29: Using the Calgary audit and feedback framework to get the most out of physician practice reports

Innovation Concept: The Calgary Audit and Feedback Framework (CAFF) is an innovative tool developed by the Physician Learning Program (PLP). By addressing four key factors –relationships, question choice, data visualization, and facilitation – CAFF addresses common barriers to physicians receiving their practice data. The goal of this study is to assess whether CAFF-facilitated physician performance improvement (PPI) sessions: 1) improve physicians’ receptiveness to their practice data, and 2) encourage physicians to both identify opportunities for practice change and create action plans. Methods: Peer facilitators were trained to facilitate PPI sessions using the CAFF model. In Calgary, 51/180 emergency physicians have attended at least one of the six PPI sessions. The sessions were evaluated using surveys, commitment to change forms, and the Feedback Orientation Scale (FOS). The FOS is a scale developed to measure a participant's orientation to performance feedback across the four domains of utility, accountability, social awareness, and feedback self-efficacy. Curriculum, Tool, or Material: The PLP has developed and implemented CAFF as a framework to help foster socially constructed learning in audit and group feedback sessions. The CAFF model ensures that the aforementioned four key factors are considered for design and implementation of audit and group feedback. The PLP found that establishing the meaning and credibility of the data is a necessary precursor to reflection and action planning. Conclusion: The FOS was completed for 25/32 physicians. The mean FOS score improved by 0.339 (p &lt; 0.001; z=−3.863). While the mean scores all four domains increased, ‘Feedback Self-Efficacy’ increased the most by .0620 (p &lt; 0.001; z=−3.999). Participants reported that examples of changes made by the peer facilitators were particularly helpful. Evaluations from the sessions suggested physicians overwhelmingly agreed or strongly agreed that the peer comparison was valuable, that the reports helped them reflect on their practice, and that the session helped them identify learning opportunities and strategies to change their practice.