Understanding Performance Report Utilization in Integrated Care: A Qualitative Assessment of Audit and Feedback for Ontario Health Teams

Background: Ontario Health Teams (OHTs) were established in Canada to transform healthcare delivery through integrated care models that improve population health and system efficiency. An essential element of integrated care is the transparency of progress, results and impact. To support the OHT integrated care models, standardized primary care performance indicator reports were distributed to all 53 OHTs as audit and feedback tools to enable transparency of progress and impact measurement. However, availability of performance data does not guarantee its use, and significant knowledge gaps existed regarding whether, how, and under what conditions diverse workforce members across OHTs utilized these reports to inform decision-making.

 

Approach: This formative qualitative evaluation employed the Clinical Performance Feedback Intervention Theory (CP-FIT) framework to examine how report characteristics (feedback), organizational conditions (context), and individual attributes (recipient) interact to influence utilization. Semi-structured interviews were conducted with 18 leaders across 6 OHTs purposively sampled for variation in perceived utilization capacity (high, intermediate, low) and role type (executive directors, implementation leads, evaluation specialists).

 

Framework analysis and rapid qualitative methods were used to synthesize findings to identify barriers and enablers for future reporting cycles. The CP-FIT framework examined feedback variables (goal alignment, data accuracy, usability, timeliness), context variables (resources, organizational capacity, collaboration structures), and recipient variables (quality improvement skills, feedback attitudes).

 

Results: OHTs demonstrated strong interest in using performance data but faced consistent barriers limiting report impact. Feedback report characteristics dominated responses (46% of coded segments): while reports aligned well with strategic goals, critical usability issues emerged including overwhelming length of reports, dense language, limited interpretive supports, and data accuracy concerns—particularly regarding missing community health center data. OHTs valued material deprivation stratifications for health equity advocacy but requested shorter audience-specific reports, clearer definitions, visual performance categorization (red-yellow-green), and dynamic dashboards enabling trend analysis. Organizational context presented equally significant barriers (46% of segments): resource constraints, competing priorities, and limited analytical capacity reduced engagement even among high-capacity OHTs.

 

External collaboration and facilitation sessions emerged as critical enablers. Recipient characteristics showed minimal barriers (8% of segments), with positive attitudes toward data use but implementation roles requiring enhanced interpretation tools. Capacity-level analysis revealed distinct patterns: high-capacity OHTs integrated reports into strategic planning despite format challenges; intermediate-capacity OHTs recognized value but struggled with interpretation; low-capacity OHTs faced fundamental resource constraints limiting application.

 

Implications: Performance feedback for strategic care integration requires dual optimization: redesigning reports for accessibility while building organizational capacity for data-driven improvement. Key lessons include: (1) report design matters—usability, clarity, and audience tailoring are essential for uptake across diverse healthcare teams; (2) organizational readiness drives use—even well-designed reports fail without adequate resourcing and analytical support; (3) facilitation bridges gaps—external change agents, peer learning communities, and co-intervention strategies effectively translate data delivery into action.

 

These findings demonstrate that successful organization-level audit and feedback strategies in integrated care settings must move beyond traditional clinical quality improvement approaches to address the unique complexities of multi-organizational partnerships, varied stakeholder capacities, and strategic population health management priorities.