Audit and feedback: effects on professional practice and health care outcomes

• Published in: Cochrane database of systematic reviews 2006-04 (2), p.CD000259-CD000259
• Main Authors: Jamtvedt, G, Young, J M, Kristoffersen, D T, O'Brien, M A, Oxman, A D
• Format: Article
• Language: English
• Subjects: Education, Medical, Continuing; Feedback, Psychological; Health Personnel - standards; Health Services Research; Humans; Medical Audit; Outcome Assessment, Health Care; Practice Patterns, Physicians' - standards; Professional Practice - standards
• ISSN: 1469-493X
• DOI: 10.1002/14651858.cd000259.pub2

Audit and feedback continues to be widely used as a strategy to improve professional practice. It appears logical that healthcare professionals would be prompted to modify their practice if given feedback that their clinical practice was inconsistent with that of their peers or accepted guidelines. Yet, audit and feedback has not consistently been found to be effective. To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes. We searched the Cochrane Effective Practice and Organisation of Care Group's register and pending file up to January 2004. Randomised trials of audit and feedback (defined as any summary of clinical performance over a specified period of time) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. Two reviewers independently extracted data and assessed study quality. Quantitative (meta-regression), visual and qualitative analyses were undertaken. For each comparison we calculated the risk difference (RD) and risk ratio (RR), adjusted for baseline compliance when possible, for dichotomous outcomes and the percentage and the percent change relative to the control group average after the intervention, adjusted for baseline performance when possible, for continuous outcomes. We investigated the following factors as possible explanations for the variation in the effectiveness of interventions across comparisons: the type of intervention (audit and feedback alone, audit and feedback with educational meetings, or multifaceted interventions that included audit and feedback), the intensity of the audit and feedback, the complexity of the targeted behaviour, the seriousness of the outcome, baseline compliance and study quality. Thirty new studies were added to this update, and a total of 118 studies are included. In the primary analysis 88 comparisons from 72 studies were included that compared any intervention in which audit and feedback is a component compared to no intervention. For dichotomous outcomes the adjusted risk difference of compliance with desired practice varied from - 0.16 (a 16 % absolute decrease in compliance) to 0.70 (a 70% increase in compliance) (median = 0.05, inter-quartile range = 0.03 to 0.11) and the adjusted risk ratio varied from 0.71 to 18.3 (median = 1.08, inter-quartile range = 0.99 to 1.30). For continuous outcomes the adjusted percent change relative to control varied from -0.10 (a 10 % absolute decrease in co