Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback

Abstract

Background: Many people advocate audit and feedback as a strategy for improving professional practice. The main results of an update of a Cochrane review on the effects of audit and feedback are reported. Data sources: The Cochrane Effective Practice and Organisation of Care Group's register up to January 2004 was searched. Randomised trials of audit and feedback that reported objectively measured professional practice in a healthcare setting or healthcare outcomes were included. Review methods: Data were independently extracted and the quality of studies were assessed by two reviewers. Quantitative, visual and qualitative analyses were undertaken. Main results: 118 trials are included in the review. In the primary analysis, 88 comparisons from 72 studies were included that compared any intervention in which audit and feedback was a component to no intervention. For dichotomous outcomes, the median-adjusted risk difference of compliance with desired practice was 5% (interquartile range 3-11). For continuous outcomes, the median-adjusted percentage change relative to control was 16% (interquartile range 5-37). Low baseline compliance with recommended practice and higher intensity of audit and feedback appeared to predict the effectiveness of audit and feedback. Conclusions: Audit and feedback can be effective in improving professional practice. The effects are generally small to moderate. The absolute effects of audit and feedback are likely to be larger when baseline adherence to recommended practice is low and intensity of audit and feedback is high.

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

“…A systematic review (173) of computerized decision support for prescribing suggested that most studies resulted in improved prescribing, although few reported on patient-relevant outcomes. Another systematic review (174) suggested that strategies that combine practice audits with feedback regarding gaps between the care provided for a particular condition and clinical practice guidelines have small to moderate effects on improving care quality. However, the effects may be larger when baseline adherence to clinical guidelines is low and intensity of audit and feedback is high.…”

“…However, the effects may be larger when baseline adherence to clinical guidelines is low and intensity of audit and feedback is high. Multifaceted interventions may also be more likely to succeed (174). Recent reviews also suggest that the greatest gain in terms of quality of care is system change with an emphasis on the multidisciplinary team approach.…”

Impact of Physician Scorecards on Emergency Department Resource Use, Quality, and Efficiency

“…21 Audit and feedback of physician practice has been used as a tool to improve resource use and care efficiency; when physicians are provided with data on how they practice, they may be more likely to consider practice changes. [22][23][24] Although insurers have been profiling providers' resource use patterns, such data are often not available to individual clinicians, usually are not acuity-adjusted, and do not include a combination of metrics that balance resource use and outcome measures. Balanced scorecards have been used in health care to provide a comprehensive picture of performance at the organizational level but have not been studied at the individual provider level.…”

Review article: Leading the future: guiding two predominant paradigm shifts in medical education through scholarship

“…36 There is mounting evidence that active learning through formative assessment and feedback has a greater impact on translation to practice. 37 In 2011, the RCPSC promoted self-directed assessment as a valued MOC activity by incentivizing their value compared with other professional development activities. 38 However, without shifting the culture of assessment by leveraging CBE, we suspect that incentivizing self-directed assessment activities will have a minimal impact.…”