Health Quality Ontario (HQO) is the provincial advisor on quality in health care. HQO currently conducts audit and feedback as a key quality improvement strategy. For example, it offers physicians working in long-term care homes with access to practice reports detailing rates of high-risk prescribing in comparison with others in Ontario and suggested change ideas. Research shows that providing this kind of feedback can lead to improvements in care. However, the size of these improvements depends how the feedback is presented. For instance, prior research suggests that how the results are 'framed' and what sort of benchmark the recipient is compared to may each affect how the physician will respond. This factorial trial tests each of these aspects of feedback design in the context of practice reports that nursing home physicians have already signed up to receive quarterly.

Inclusion Criteria:

• a physician licensed by the College of Physicians and Surgeons of Ontario (CPSO);
• practice in at least one LTC facility in Ontario;.
• have voluntarily signed up to receive an HQO practice report

Exclusion Criteria:

• n/a

Analyses of outcomes use routine administrative database holdings.