Audit and feedback: effects on professional practice and healthcare outcomes
Background Audit and feedback is widely used as a strategy to improve professional practice either on its own or as a component of multifaceted quality improvement interventions. This is based on the belief that healthcare professionals are prompted to modify their practice when given performance fe...
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| Veröffentlicht in: | Cochrane database of systematic reviews 2012-06, Vol.2012 (7), p.CD000259 |
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| creator | Ivers, Noah Jamtvedt, Gro Flottorp, Signe Young, Jane M Odgaard‐Jensen, Jan French, Simon D O'Brien, Mary Ann Johansen, Marit Grimshaw, Jeremy Oxman, Andrew D Ivers, Noah |
| description | Background
Audit and feedback is widely used as a strategy to improve professional practice either on its own or as a component of multifaceted quality improvement interventions. This is based on the belief that healthcare professionals are prompted to modify their practice when given performance feedback showing that their clinical practice is inconsistent with a desirable target. Despite its prevalence as a quality improvement strategy, there remains uncertainty regarding both the effectiveness of audit and feedback in improving healthcare practice and the characteristics of audit and feedback that lead to greater impact.
Objectives
To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes and to examine factors that may explain variation in the effectiveness of audit and feedback.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2010, Issue 4, part of The Cochrane Library. www.thecochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 10 December 2010); MEDLINE, Ovid (1950 to November Week 3 2010) (searched 09 December 2010); EMBASE, Ovid (1980 to 2010 Week 48) (searched 09 December 2010); CINAHL, Ebsco (1981 to present) (searched 10 December 2010); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (1975 to present) (searched 12‐15 September 2011).
Selection criteria
Randomised trials of audit and feedback (defined as a summary of clinical performance over a specified period of time) that reported objectively measured health professional practice or patient outcomes. In the case of multifaceted interventions, only trials in which audit and feedback was considered the core, essential aspect of at least one intervention arm were included.
Data collection and analysis
All data were ed by two independent review authors. For the primary outcome(s) in each study, we calculated the median absolute risk difference (RD) (adjusted for baseline performance) of compliance with desired practice compliance for dichotomous outcomes and the median percent change relative to the control group for continuous outcomes. Across studies the median effect size was weighted by number of health professionals involved in each study. We investigated the following factors as possible explanations for the variation in the effectiveness of interventions across comparisons: format of feedback, |
| doi_str_mv | 10.1002/14651858.CD000259.pub3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11338587</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1020833541</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5453-b4d11006b3f5642a927f8f93b5a09ea2aaa6b3667b720386847ed0e070ae033c3</originalsourceid><addsrcrecordid>eNqFUctOwzAQtBCIlsIvVDlyabHjxEm4oFKeUiUucLY2zpoG0rjYCah_j0MfKlw42auZndndIWTI6JhRGl6wSMQsjdPx9Ib6Os7GyzbnB6TfAaMOOdz798iJc2-UcpGFyTHphaHIBGdpn8wmbVE2AdRFoBGLHNT7ZYBao2pcYOpgaY1G50pTQ-ULUE2p8Ic-R6iauQKLgWkbZRboTsmRhsrh2eYdkJe72-fpw2j2dP84ncxGKo5iPsqjgvklRM51LKIQ_Ew61RnPY6AZQggAHhMiyZOQ8lSkUYIFRZpQQMq54gNytdb1Oy-wUFg3Fiq5tOUC7EoaKOVvpC7n8tV8SsY49-dIvML5RsGajxZdIxelU1hVUKNpnWQ0pCnnccQ8VaypyhrnLOqdD6Oyy0Jus5DbLDp37huH-1Pu2rbH94TrNeGrrHAllVFz6_3_0f3j8g3Fc5o3</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1020833541</pqid></control><display><type>article</type><title>Audit and feedback: effects on professional practice and healthcare outcomes</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Ivers, Noah ; Jamtvedt, Gro ; Flottorp, Signe ; Young, Jane M ; Odgaard‐Jensen, Jan ; French, Simon D ; O'Brien, Mary Ann ; Johansen, Marit ; Grimshaw, Jeremy ; Oxman, Andrew D ; Ivers, Noah</creator><creatorcontrib>Ivers, Noah ; Jamtvedt, Gro ; Flottorp, Signe ; Young, Jane M ; Odgaard‐Jensen, Jan ; French, Simon D ; O'Brien, Mary Ann ; Johansen, Marit ; Grimshaw, Jeremy ; Oxman, Andrew D ; Ivers, Noah</creatorcontrib><description>Background
Audit and feedback is widely used as a strategy to improve professional practice either on its own or as a component of multifaceted quality improvement interventions. This is based on the belief that healthcare professionals are prompted to modify their practice when given performance feedback showing that their clinical practice is inconsistent with a desirable target. Despite its prevalence as a quality improvement strategy, there remains uncertainty regarding both the effectiveness of audit and feedback in improving healthcare practice and the characteristics of audit and feedback that lead to greater impact.
Objectives
To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes and to examine factors that may explain variation in the effectiveness of audit and feedback.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2010, Issue 4, part of The Cochrane Library. www.thecochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 10 December 2010); MEDLINE, Ovid (1950 to November Week 3 2010) (searched 09 December 2010); EMBASE, Ovid (1980 to 2010 Week 48) (searched 09 December 2010); CINAHL, Ebsco (1981 to present) (searched 10 December 2010); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (1975 to present) (searched 12‐15 September 2011).
Selection criteria
Randomised trials of audit and feedback (defined as a summary of clinical performance over a specified period of time) that reported objectively measured health professional practice or patient outcomes. In the case of multifaceted interventions, only trials in which audit and feedback was considered the core, essential aspect of at least one intervention arm were included.
Data collection and analysis
All data were ed by two independent review authors. For the primary outcome(s) in each study, we calculated the median absolute risk difference (RD) (adjusted for baseline performance) of compliance with desired practice compliance for dichotomous outcomes and the median percent change relative to the control group for continuous outcomes. Across studies the median effect size was weighted by number of health professionals involved in each study. We investigated the following factors as possible explanations for the variation in the effectiveness of interventions across comparisons: format of feedback, source of feedback, frequency of feedback, instructions for improvement, direction of change required, baseline performance, profession of recipient, and risk of bias within the trial itself. We also conducted exploratory analyses to assess the role of context and the targeted clinical behaviour. Quantitative (meta‐regression), visual, and qualitative analyses were undertaken to examine variation in effect size related to these factors.
Main results
We included and analysed 140 studies for this review. In the main analyses, a total of 108 comparisons from 70 studies compared any intervention in which audit and feedback was a core, essential component to usual care and evaluated effects on professional practice. After excluding studies at high risk of bias, there were 82 comparisons from 49 studies featuring dichotomous outcomes, and the weighted median adjusted RD was a 4.3% (interquartile range (IQR) 0.5% to 16%) absolute increase in healthcare professionals' compliance with desired practice. Across 26 comparisons from 21 studies with continuous outcomes, the weighted median adjusted percent change relative to control was 1.3% (IQR = 1.3% to 28.9%). For patient outcomes, the weighted median RD was ‐0.4% (IQR ‐1.3% to 1.6%) for 12 comparisons from six studies reporting dichotomous outcomes and the weighted median percentage change was 17% (IQR 1.5% to 17%) for eight comparisons from five studies reporting continuous outcomes. Multivariable meta‐regression indicated that feedback may be more effective when baseline performance is low, the source is a supervisor or colleague, it is provided more than once, it is delivered in both verbal and written formats, and when it includes both explicit targets and an action plan. In addition, the effect size varied based on the clinical behaviour targeted by the intervention.
Authors' conclusions
Audit and feedback generally leads to small but potentially important improvements in professional practice. The effectiveness of audit and feedback seems to depend on baseline performance and how the feedback is provided. Future studies of audit and feedback should directly compare different ways of providing feedback.</description><identifier>ISSN: 1465-1858</identifier><identifier>ISSN: 1469-493X</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD000259.pub3</identifier><identifier>PMID: 22696318</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Education, Medical, Continuing ; Effective practice & health systems ; Feedback, Psychological ; Health Personnel ; Health Personnel - standards ; Health Services Research ; Humans ; Implementation strategies ; Interventions targeted at healthcare workers ; Medical Audit ; Medical Audit - standards ; Medicine General & Introductory Medical Sciences ; Outcome Assessment, Health Care ; Practice Patterns, Physicians ; Practice Patterns, Physicians' - standards ; Professional Practice ; Professional Practice - standards ; Randomized Controlled Trials as Topic</subject><ispartof>Cochrane database of systematic reviews, 2012-06, Vol.2012 (7), p.CD000259</ispartof><rights>Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5453-b4d11006b3f5642a927f8f93b5a09ea2aaa6b3667b720386847ed0e070ae033c3</citedby><cites>FETCH-LOGICAL-c5453-b4d11006b3f5642a927f8f93b5a09ea2aaa6b3667b720386847ed0e070ae033c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22696318$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ivers, Noah</creatorcontrib><creatorcontrib>Jamtvedt, Gro</creatorcontrib><creatorcontrib>Flottorp, Signe</creatorcontrib><creatorcontrib>Young, Jane M</creatorcontrib><creatorcontrib>Odgaard‐Jensen, Jan</creatorcontrib><creatorcontrib>French, Simon D</creatorcontrib><creatorcontrib>O'Brien, Mary Ann</creatorcontrib><creatorcontrib>Johansen, Marit</creatorcontrib><creatorcontrib>Grimshaw, Jeremy</creatorcontrib><creatorcontrib>Oxman, Andrew D</creatorcontrib><creatorcontrib>Ivers, Noah</creatorcontrib><title>Audit and feedback: effects on professional practice and healthcare outcomes</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Audit and feedback is widely used as a strategy to improve professional practice either on its own or as a component of multifaceted quality improvement interventions. This is based on the belief that healthcare professionals are prompted to modify their practice when given performance feedback showing that their clinical practice is inconsistent with a desirable target. Despite its prevalence as a quality improvement strategy, there remains uncertainty regarding both the effectiveness of audit and feedback in improving healthcare practice and the characteristics of audit and feedback that lead to greater impact.
Objectives
To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes and to examine factors that may explain variation in the effectiveness of audit and feedback.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2010, Issue 4, part of The Cochrane Library. www.thecochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 10 December 2010); MEDLINE, Ovid (1950 to November Week 3 2010) (searched 09 December 2010); EMBASE, Ovid (1980 to 2010 Week 48) (searched 09 December 2010); CINAHL, Ebsco (1981 to present) (searched 10 December 2010); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (1975 to present) (searched 12‐15 September 2011).
Selection criteria
Randomised trials of audit and feedback (defined as a summary of clinical performance over a specified period of time) that reported objectively measured health professional practice or patient outcomes. In the case of multifaceted interventions, only trials in which audit and feedback was considered the core, essential aspect of at least one intervention arm were included.
Data collection and analysis
All data were ed by two independent review authors. For the primary outcome(s) in each study, we calculated the median absolute risk difference (RD) (adjusted for baseline performance) of compliance with desired practice compliance for dichotomous outcomes and the median percent change relative to the control group for continuous outcomes. Across studies the median effect size was weighted by number of health professionals involved in each study. We investigated the following factors as possible explanations for the variation in the effectiveness of interventions across comparisons: format of feedback, source of feedback, frequency of feedback, instructions for improvement, direction of change required, baseline performance, profession of recipient, and risk of bias within the trial itself. We also conducted exploratory analyses to assess the role of context and the targeted clinical behaviour. Quantitative (meta‐regression), visual, and qualitative analyses were undertaken to examine variation in effect size related to these factors.
Main results
We included and analysed 140 studies for this review. In the main analyses, a total of 108 comparisons from 70 studies compared any intervention in which audit and feedback was a core, essential component to usual care and evaluated effects on professional practice. After excluding studies at high risk of bias, there were 82 comparisons from 49 studies featuring dichotomous outcomes, and the weighted median adjusted RD was a 4.3% (interquartile range (IQR) 0.5% to 16%) absolute increase in healthcare professionals' compliance with desired practice. Across 26 comparisons from 21 studies with continuous outcomes, the weighted median adjusted percent change relative to control was 1.3% (IQR = 1.3% to 28.9%). For patient outcomes, the weighted median RD was ‐0.4% (IQR ‐1.3% to 1.6%) for 12 comparisons from six studies reporting dichotomous outcomes and the weighted median percentage change was 17% (IQR 1.5% to 17%) for eight comparisons from five studies reporting continuous outcomes. Multivariable meta‐regression indicated that feedback may be more effective when baseline performance is low, the source is a supervisor or colleague, it is provided more than once, it is delivered in both verbal and written formats, and when it includes both explicit targets and an action plan. In addition, the effect size varied based on the clinical behaviour targeted by the intervention.
Authors' conclusions
Audit and feedback generally leads to small but potentially important improvements in professional practice. The effectiveness of audit and feedback seems to depend on baseline performance and how the feedback is provided. Future studies of audit and feedback should directly compare different ways of providing feedback.</description><subject>Education, Medical, Continuing</subject><subject>Effective practice & health systems</subject><subject>Feedback, Psychological</subject><subject>Health Personnel</subject><subject>Health Personnel - standards</subject><subject>Health Services Research</subject><subject>Humans</subject><subject>Implementation strategies</subject><subject>Interventions targeted at healthcare workers</subject><subject>Medical Audit</subject><subject>Medical Audit - standards</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Outcome Assessment, Health Care</subject><subject>Practice Patterns, Physicians</subject><subject>Practice Patterns, Physicians' - standards</subject><subject>Professional Practice</subject><subject>Professional Practice - standards</subject><subject>Randomized Controlled Trials as Topic</subject><issn>1465-1858</issn><issn>1469-493X</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFUctOwzAQtBCIlsIvVDlyabHjxEm4oFKeUiUucLY2zpoG0rjYCah_j0MfKlw42auZndndIWTI6JhRGl6wSMQsjdPx9Ib6Os7GyzbnB6TfAaMOOdz798iJc2-UcpGFyTHphaHIBGdpn8wmbVE2AdRFoBGLHNT7ZYBao2pcYOpgaY1G50pTQ-ULUE2p8Ic-R6iauQKLgWkbZRboTsmRhsrh2eYdkJe72-fpw2j2dP84ncxGKo5iPsqjgvklRM51LKIQ_Ew61RnPY6AZQggAHhMiyZOQ8lSkUYIFRZpQQMq54gNytdb1Oy-wUFg3Fiq5tOUC7EoaKOVvpC7n8tV8SsY49-dIvML5RsGajxZdIxelU1hVUKNpnWQ0pCnnccQ8VaypyhrnLOqdD6Oyy0Jus5DbLDp37huH-1Pu2rbH94TrNeGrrHAllVFz6_3_0f3j8g3Fc5o3</recordid><startdate>20120613</startdate><enddate>20120613</enddate><creator>Ivers, Noah</creator><creator>Jamtvedt, Gro</creator><creator>Flottorp, Signe</creator><creator>Young, Jane M</creator><creator>Odgaard‐Jensen, Jan</creator><creator>French, Simon D</creator><creator>O'Brien, Mary Ann</creator><creator>Johansen, Marit</creator><creator>Grimshaw, Jeremy</creator><creator>Oxman, Andrew D</creator><creator>Ivers, Noah</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20120613</creationdate><title>Audit and feedback: effects on professional practice and healthcare outcomes</title><author>Ivers, Noah ; Jamtvedt, Gro ; Flottorp, Signe ; Young, Jane M ; Odgaard‐Jensen, Jan ; French, Simon D ; O'Brien, Mary Ann ; Johansen, Marit ; Grimshaw, Jeremy ; Oxman, Andrew D ; Ivers, Noah</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5453-b4d11006b3f5642a927f8f93b5a09ea2aaa6b3667b720386847ed0e070ae033c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Education, Medical, Continuing</topic><topic>Effective practice & health systems</topic><topic>Feedback, Psychological</topic><topic>Health Personnel</topic><topic>Health Personnel - standards</topic><topic>Health Services Research</topic><topic>Humans</topic><topic>Implementation strategies</topic><topic>Interventions targeted at healthcare workers</topic><topic>Medical Audit</topic><topic>Medical Audit - standards</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Outcome Assessment, Health Care</topic><topic>Practice Patterns, Physicians</topic><topic>Practice Patterns, Physicians' - standards</topic><topic>Professional Practice</topic><topic>Professional Practice - standards</topic><topic>Randomized Controlled Trials as Topic</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ivers, Noah</creatorcontrib><creatorcontrib>Jamtvedt, Gro</creatorcontrib><creatorcontrib>Flottorp, Signe</creatorcontrib><creatorcontrib>Young, Jane M</creatorcontrib><creatorcontrib>Odgaard‐Jensen, Jan</creatorcontrib><creatorcontrib>French, Simon D</creatorcontrib><creatorcontrib>O'Brien, Mary Ann</creatorcontrib><creatorcontrib>Johansen, Marit</creatorcontrib><creatorcontrib>Grimshaw, Jeremy</creatorcontrib><creatorcontrib>Oxman, Andrew D</creatorcontrib><creatorcontrib>Ivers, Noah</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ivers, Noah</au><au>Jamtvedt, Gro</au><au>Flottorp, Signe</au><au>Young, Jane M</au><au>Odgaard‐Jensen, Jan</au><au>French, Simon D</au><au>O'Brien, Mary Ann</au><au>Johansen, Marit</au><au>Grimshaw, Jeremy</au><au>Oxman, Andrew D</au><au>Ivers, Noah</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Audit and feedback: effects on professional practice and healthcare outcomes</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2012-06-13</date><risdate>2012</risdate><volume>2012</volume><issue>7</issue><spage>CD000259</spage><pages>CD000259-</pages><issn>1465-1858</issn><issn>1469-493X</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Audit and feedback is widely used as a strategy to improve professional practice either on its own or as a component of multifaceted quality improvement interventions. This is based on the belief that healthcare professionals are prompted to modify their practice when given performance feedback showing that their clinical practice is inconsistent with a desirable target. Despite its prevalence as a quality improvement strategy, there remains uncertainty regarding both the effectiveness of audit and feedback in improving healthcare practice and the characteristics of audit and feedback that lead to greater impact.
Objectives
To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes and to examine factors that may explain variation in the effectiveness of audit and feedback.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2010, Issue 4, part of The Cochrane Library. www.thecochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 10 December 2010); MEDLINE, Ovid (1950 to November Week 3 2010) (searched 09 December 2010); EMBASE, Ovid (1980 to 2010 Week 48) (searched 09 December 2010); CINAHL, Ebsco (1981 to present) (searched 10 December 2010); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (1975 to present) (searched 12‐15 September 2011).
Selection criteria
Randomised trials of audit and feedback (defined as a summary of clinical performance over a specified period of time) that reported objectively measured health professional practice or patient outcomes. In the case of multifaceted interventions, only trials in which audit and feedback was considered the core, essential aspect of at least one intervention arm were included.
Data collection and analysis
All data were ed by two independent review authors. For the primary outcome(s) in each study, we calculated the median absolute risk difference (RD) (adjusted for baseline performance) of compliance with desired practice compliance for dichotomous outcomes and the median percent change relative to the control group for continuous outcomes. Across studies the median effect size was weighted by number of health professionals involved in each study. We investigated the following factors as possible explanations for the variation in the effectiveness of interventions across comparisons: format of feedback, source of feedback, frequency of feedback, instructions for improvement, direction of change required, baseline performance, profession of recipient, and risk of bias within the trial itself. We also conducted exploratory analyses to assess the role of context and the targeted clinical behaviour. Quantitative (meta‐regression), visual, and qualitative analyses were undertaken to examine variation in effect size related to these factors.
Main results
We included and analysed 140 studies for this review. In the main analyses, a total of 108 comparisons from 70 studies compared any intervention in which audit and feedback was a core, essential component to usual care and evaluated effects on professional practice. After excluding studies at high risk of bias, there were 82 comparisons from 49 studies featuring dichotomous outcomes, and the weighted median adjusted RD was a 4.3% (interquartile range (IQR) 0.5% to 16%) absolute increase in healthcare professionals' compliance with desired practice. Across 26 comparisons from 21 studies with continuous outcomes, the weighted median adjusted percent change relative to control was 1.3% (IQR = 1.3% to 28.9%). For patient outcomes, the weighted median RD was ‐0.4% (IQR ‐1.3% to 1.6%) for 12 comparisons from six studies reporting dichotomous outcomes and the weighted median percentage change was 17% (IQR 1.5% to 17%) for eight comparisons from five studies reporting continuous outcomes. Multivariable meta‐regression indicated that feedback may be more effective when baseline performance is low, the source is a supervisor or colleague, it is provided more than once, it is delivered in both verbal and written formats, and when it includes both explicit targets and an action plan. In addition, the effect size varied based on the clinical behaviour targeted by the intervention.
Authors' conclusions
Audit and feedback generally leads to small but potentially important improvements in professional practice. The effectiveness of audit and feedback seems to depend on baseline performance and how the feedback is provided. Future studies of audit and feedback should directly compare different ways of providing feedback.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>22696318</pmid><doi>10.1002/14651858.CD000259.pub3</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2012-06, Vol.2012 (7), p.CD000259 |
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| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11338587 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Education, Medical, Continuing Effective practice & health systems Feedback, Psychological Health Personnel Health Personnel - standards Health Services Research Humans Implementation strategies Interventions targeted at healthcare workers Medical Audit Medical Audit - standards Medicine General & Introductory Medical Sciences Outcome Assessment, Health Care Practice Patterns, Physicians Practice Patterns, Physicians' - standards Professional Practice Professional Practice - standards Randomized Controlled Trials as Topic |
| title | Audit and feedback: effects on professional practice and healthcare outcomes |
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