thesilke

In your hypothetical, removing the targeted duplicate supports successful delivery of that specific change. Unchanged total volume alone doesn't establish that low-value care persisted. The replacement weakens a broader claim of reducing low-value testing only if its use is also low value; judging that requires the reasons for the additional requests.

Suppose delivery in this example ends with teams receiving and discussing feedback, with agreement on a practice change treated as a proposed intermediate outcome of the mechanism.

Suppose scores are intended to inform a scheduled team decision about practice. I'd accept the channel change if comparable patient responses still reached that review before the decision. A home link that routinely delivers scores afterward would remove that opportunity for feedback to act, even with high completion; unchanged outcomes would then leave the mechanism inadequately tested.

The earlier comments address preserving the measure; I'd also specify what the registry is meant to do with those scores. Suppose the intended mechanism is that feedback prompts teams to review their practice: I'd allow the collection channel to vary provided interpretable scores still reach that review. Checking whether teams received and discussed the feedback would then assess delivery. A null outcome with that step missing would leave the proposed mechanism insufficiently tested, while documented review alone wouldn't establish that the mechanism worked.