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Several participants expressed a preference for individual level feedback.
For example, individual level feedback could reasonably be assumed to be more personally relevant and persuasive and thus more effective than feedback at a group level; there are no such direct comparisons available.
Improvements in biochemical dietary markers and reduced risk in cardiovascular disease have been demonstrated in two remote Aboriginal Australian communities in association with community-led initiatives which included improving the availability of healthy food in the store and providing individual level feedback on health status and dietary messages [ 29, 30].
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In addition, providing combined group- and individual-level feedback appeared to have a positive effect.
For example, systematic reviews of PROMs feedback at the individual level demonstrate a pattern of outcomes such that PROMs feedback influences communication within the consultation and increases the detection of problems but has much less impact on patient management or outcomes.
5 7 At the individual level, the intention of PROMs feedback is to enhance communication between patients and clinicians, improve the detection of patient problems, support clinical decision-making about treatment through ongoing monitoring and to empower patients to become more involved in their care.
25 Finally, research coverage of PROMs feedback is uneven, with more studies (trials and qualitative case studies) examining PROMs feedback at an individual level and few studies examining their use as a performance indicator at a group level.
In Table 2, the four most often used individual level methods are: Goal Setting, Facilitation, Feedback, and Consciousness Raising.
A recent systematic review examined instruments designed to evaluate patients' experiences with individual practicing physicians and whether they are able to provide performance feedback at the individual level [ 34].
The synthesis is very ambitious and the literature in this area is large but uneven, with many more studies of PROMs feedback at an individual level compared to the aggregate level.
The foremost task in overcoming the current limitations is supporting current fellows by providing timely feedback at the individual level and establishing cooperative relationships for continuous support at the organizational level in the long term.
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