Conclusions
fits
This head-to-head trial of A&F delivered at scale found no impact of variations in either the benchmark used for comparison, or the framing of information, on physician prescribing of CNS-active medications to nursing home residents. However, we could not fully answer our research questions due to a lack of engagement with the report. The process evaluation indicated that a comparator representing a higher target can encourage behaviour change if physicians identify with it. In addition, feedback framed to emphasize the potential risk to patients is more actionable and more compatible with current workflows. Those designing and delivering A&F should consider the actionability of their indicators, how their report fits with current workflows, and the use of a comparator which may more likely represent a difficult but achievable goal. A&F researchers should explore the impact on A&F effectiveness of strategies for enhancing engagement, different types of tailored comparators, and co-interventions to support behavior change within healthcare teams.