This review will apply Arksey and O’Malley’s framework for scoping reviews [16]. This framework contains five steps: 1) research question identification; 2) relevant studies identification; 3) studies selection; 4) data charting; and 5) data collating and summarising [14]. The structure of this review will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist [17]. This protocol has been registered prospectively with the Open Science Framework (OSF) DOI 10.17605/OSF.IO/FHM4N [18].
3.1 Step 1: Formulating the research question
The question was formulated according to the population or problem, the phenomena of interest, and the context (PICo) mnemonic (see Table 1). The PICo mnemonic is utilised to develop a well-defined and significant question and can be used to frame and organise the search strategy [19].
Table 1. PICo mnemonic
Population (P)
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Phenomena of interest (I)
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Context (Co)
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Healthcare providers clinical quality registry healthcare setting
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Barriers and facilitators using feedback systems
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Clinical quality registries
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Abbreviations: PICo: population phenomena of interest context.
3.2 Step 2: Identifying relevant studies
The following electronic databases will be searched for relevant studies: MEDLINE via Ovid, CINAHL, and Scopus. Table 2 presents the terms used in the search strategy. The search will be limited to articles published between 2000 and 2023 to find the most up-to-date primary research studies. These databases have been selected because their concepts are relevant to the nursing, health, and medical fields [20]. The references in the selected articles will be manually searched to ensure that relevant additional literature is identified. The grey literature (Google Scholar) will also be searched to ensure that all relevant data has been captured (only the first 10 pages will be searched). A health services librarian (RL) assisted in developing the search strategies which incorporated keywords related to the topic of interest. These strategies were based on the specific descriptors used by each database including index terms, Boolean operators, and truncation.
Table 2. Search terms and keywords
Concept 1 (Registries)
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Concept 2 (Feedback)
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Concept 3 (Implementation)
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Concept 4 (Barriers and facilitators)
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Concept 5 (Health service)
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Clinical audit (MeSH) Benchmark* Clinical registr* “Clinical quality registr”
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Report “Audit and feedback” Dashboard
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Implement* develop* fulfill* advance* improv* progress* establish* design*
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“barrier* and facilitator*” Barrier* Facilitator* Enabler* Challeng* engag* disincent* incent*
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Health care Healthcare Hospital Health service* Health facility*
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3.3 Phase 3: Study selection
3.3.1 Eligibility criteria
After searching the relevant databases, the retrieved articles (including abstracts) will be downloaded to an Endnote library, and then imported to Covidence [21] where duplicates were removed, and titles/abstracts and full-text articles will be screened. The articles will be selected according to the following eligibility criteria:
3.3.1.1 Inclusion
- Hospital-based clinical quality registries
- Studies that investigated the barriers and enablers of using feedback systems of CQR
- Qualitative studies
- Mixed method studies (only qualitative components will be included)
- English language
3.3.1.2 Exclusion
- Other registries such as animal-based registries, primary registries, and device-related registries
- Hospital audits
- Quantitative studies, longitudinal or cohort studies
- Reviews, commentaries, and editorials
- Studies that investigated other CQR outcomes such as the impact on patients' outcomes
- Published prior 2000 to find the most up-to-date and contemporary primary research studies
- Scientific conference abstracts
Two independent reviewers will examine the titles and abstracts (HA, SA, and JM). Full-text articles will be downloaded and reviewed by the same reviewers, independently. Any conflicts will be resolved by a third reviewer (CF). The study selection workflow will be summarised in a PRISMA flowchart (Figure 2).
3.4 Phase 4: Charting data
A data extraction form will be developed in Covidence [21] to chart the data. Charting involves examining, organising, and categorising materials according to their defining characteristics [16]. Table 3 provides the following details: author name and publication year, the aim of the study, country, study design, methodology, number of participants, roles, type of registry, feedback mechanism, frequency of providing feedback, factors affecting use of feedback (barriers, enablers, and strategies to overcome the barriers). Each reviewer will extract the data independently and compared it at the end to resolve discrepancies and reach a consensus on data selection. The data was assessed using the Joanna Briggs Institute (JBI) [22] critical appraisal tool for qualitative studies and the five-step mixed-method appraisal tool for mixed-method studies [23] developed in Covidence [21].
Table 3. Data charting
Author and year
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Aim
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Countries
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Study design
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Methodology
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Number of participants
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Role
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Registry type
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Feedback mechanism
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Core components
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Frequency of providing feedback
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Factors
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3.5 Phase 5: Collating, summarising, and presenting the result
Firstly, the extracted data was mapped against a previously-selected conceptual framework [15], and a coding framework was created. The analysed data was presented in either a diagrammatic or tabular form aligned with the objectives of this scoping review. The tables and charts present the factors that affect the optimal use of feedback from CQRs, as well as the strategies employed to overcome the identified barriers and encourage the facilitators. A summary is provided of the data interpretation and an explanation of its alignment with the objective and queries of the review.