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

Jamtvedt, Gro; Young, Jane M; Kristoffersen, Doris Tove; O'Brien, Mary Ann; Oxman, Andrew D

doi:10.1002/14651858.cd000259.pub2

Cited by 918Health Policy Implementation ScienceClinical practice guidelines implementationHealth Sciences Research and Education

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

Jamtvedt, Gro, Young, Jane M, Kristoffersen, Doris Tove, O'Brien, Mary Ann, Oxman, Andrew D·2006·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd000259.pub2

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Abstract

BACKGROUND: 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. OBJECTIVES: To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group's register and pending file up to January 2004. SELECTION CRITERIA: 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. DATA COLLECTION AND ANALYSIS: 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. MAIN RESULTS: 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 compliance) to 0.68 (a 68% increase in compliance) (median = 0.16, inter-quartile range = 0.05 to 0.37). Low baseline compliance with recommended practice and higher intensity of audit and feedback were associated with larger adjusted risk ratios (greater effectiveness) across studies. AUTHORS' CONCLUSIONS: Audit and feedback can be effective in improving professional practice. When it is effective, the effects are generally small to moderate. The relative effectiveness of audit and feedback is likely to be greater when baseline adherence to recommended practice is low and when feedback is delivered more intensively.

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Use of a chart audit: teaching well child care to paediatric house officers
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The effect of quality assurance activities on the quality of mental health services.
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Intervention against Long-term use of Hypnotics/Sedatives in General Practice
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Laboratory investigation utilization in pediatric out-patient department Ramathibodi Hospital.
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Physician profiles in training the graduate internist
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Impact of Resident Feedback on Immunization Outcomes
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Feedback of Laboratory Usage and Cost Data to Clinicians: Does it Alter Requesting Behaviour?
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Comparison of an Enhanced Versus a Written Feedback Model on the Management of Medicare Inpatients with Venous Thrombosis
Hayes, R. P., Armour, B. S., Bratzler, D. W., Moore, L., Murray, C. K., Stevens, B. R., Radford, M. J., Fitzgerald, D., Elward, K. S., & Ballard, D. J. (2001) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(01)27014-x · Cited by 15 · see citing works
Impact of a Therapeutic Drug Monitoring Program for Digoxin
Wing, D. (1987) · Archives of Internal Medicine · doi:10.1001/archinte.1987.00370080041010 · Cited by 14 · see citing works
Can peer-comparison feedback improve patient functional status?
Weingarten, S. R., Kim, C. S., Stone, E. G., Kristopaitis, R., Pelter, M. A., & Sandhu, M. (2000) · PubMed · Cited by 14 · see citing works
Efficacy of Feedback From Quarterly Laboratory Comparison in Maintaining Quality of a Hospital Capillary Blood Glucose Monitoring Program
Jones, H. E., Cleave, B., Zinman, B., Szalai, J. P., Nichol, H., & Hoffman, B. (1996) · Diabetes Care · doi:10.2337/diacare.19.2.168 · Cited by 13 · see citing works
Improving general practitioner clinical records with a quality assurance minimal intervention.
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Randomised trial of intensive academic detailing to promote opportunistic recruitment of women to cervical screening by general practitioners
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Self-citation
REACTIONS OF DOCTORS TO VARIOUS FORMS OF FEEDBACK DESIGNED TO IMPROVE SAMPLING QUALITY OF CERVICAL SMEARS
Buntinx, F., Knottnerus, J. A., Crebolder, H. F. J. M., & Essed, G. G. M. (1992) · International Journal for Quality in Health Care · doi:10.1093/oxfordjournals.intqhc.a036711 · Cited by 13 · see citing works
Modifying empiric antibiotic prescribing: experience with one strategy in a medical residency program.
Pe, M., & Gartenberg, G. (1985) · PubMed · Cited by 12 · see citing works
Using audit to improve senior house officer training
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Evaluation of a Therapeutic Drug Monitoring Program for Theophylline in a Teaching Hospital
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Improving Prescription-Writing Skills in a Family Practice Residency
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The Effect of a Drug and Supply Cost Feedback System on the Use of Intraoperative Resources by Anesthesiologists
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Health care provider quality improvement organization Medicare data-sharing: a diabetes quality improvement initiative.
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Does awareness of rates of obstetric interventions change practice?
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Flagged first, then by citations

3 of the 207 references couldn’t be matched to a known paper.

Sorted by citations

Audit and feedback: effects on professional practice and healthcare outcomes
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., O'Brien, M. A., Johansen, M., Grimshaw, J., & Oxman, A. D. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub3 · Cited by 5,485 · see citing works
Self-citation
Implementation strategies: recommendations for specifying and reporting
Proctor, E. K., Powell, B. J., & McMillen, J. C. (2013) · Implementation Science · doi:10.1186/1748-5908-8-139 · Cited by 2,585 · see citing works
Knowledge translation of research findings
Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012) · Implementation Science · doi:10.1186/1748-5908-7-50 · Cited by 2,407 · see citing works
Educational outreach visits: effects on professional practice and health care outcomes
O'Brien, M. A., Rogers, S., Jamtvedt, G., Oxman, A. D., Odgaard-Jensen, J., Kristoffersen, D. T., Forsetlund, L., Bainbridge, D., Freemantle, N., Davis, D., et al. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000409.pub2 · Cited by 1,279 · see citing works
Self-citation
Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update
Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L. R., Nyquist, A., Saiman, L. M., Yokoe, D. S., Maragakis, L. L., et al. (2014) · Infection Control and Hospital Epidemiology · doi:10.1086/676022 · Cited by 1,216 · see citing works
“dividual surgeons, the surgical division and/or department chiefs, and hospital leadership.(17,130) i.”
Background
Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS ® ) Society Recommendations
Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N. K., McNaught, C., Macfie, J. M., Liberman, A. S., Soop, M., et al. (2012) · World Journal of Surgery · doi:10.1007/s00268-012-1772-0 · Cited by 1,130 · see citing works
“Measuring standards and auditing the quality of healthcare drive continue to improve practice [209].”
Background
Local opinion leaders: effects on professional practice and health care outcomes
Flodgren, G., Parmelli, E., Doumit, G., Gattellari, M., O'Brien, M. A., Grimshaw, J., & Eccles, M. P. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000125.pub4 · Cited by 1,070 · see citing works
Self-citation
Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes
Baker, R., Camosso-Stefinovic, J., Gillies, C., Shaw, E. J., Cheater, F., Flottorp, S., & Robertson, N. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005470.pub2 · Cited by 1,003 · see citing works
Printed educational materials: effects on professional practice and healthcare outcomes
Giguere, A. M. C., Légaré, F., Grimshaw, J., Turcotte, S., Fiander, M., Grudniewicz, A., Makosso‐Kallyth, S., Wolf, F. M., Farmer, A. P., & Gagnon, M. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004398.pub3 · Cited by 879 · see citing works
Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices
Meeker, D., Linder, J. A., Fox, C. R., Friedberg, M. W., Persell, S. D., Goldstein, N. J., Knight, T. K., Hay, J. W., & Doctor, J. N. (2016) · JAMA · doi:10.1001/jama.2016.0275 · Cited by 861 · see citing works
“(%) 5567 (33) 727 (35) 675 (28) 830 (42) 511 (32) 617 (29) 631 (31) 753 (34) 823 (33)”
Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations
Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N. K., McNaught, C., Macfie, J. M., Liberman, A. S., Soop, M., et al. (2012) · Clinical Nutrition · doi:10.1016/j.clnu.2012.08.013 · Cited by 837 · see citing works
Demystifying theory and its use in improvement
Davidoff, F., Dixon-Woods, M., Leviton, L., & Michie, S. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003627 · Cited by 714 · see citing works
“38 39 Failure to use the various elements of formal theory adequately has frustrated the efficacy and 40 was able to offer few useful recommendations on making this technique effective because of weaknesses in the theoretical underpinning of this review ’ s analysis.”
Background
Interventions to improve antibiotic prescribing practices in ambulatory care
Arnold, S. R., & Straus, S. E. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003539.pub2 · Cited by 716 · see citing works
Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries
Huttner, B. D., Goossens, H., Verheij, T. J., & Harbarth, S. (2009) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(09)70305-6 · Cited by 573 · see citing works
Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations
Lassen, K., Coolsen, M. M. E., Slim, K., Carli, F., de Aguilar‐Nascimento, J. E., Schäfer, M., Parks, R. W., Fearon, K. C. H., Lobo, D. N., Demartines, N., et al. (2012) · Clinical Nutrition · doi:10.1016/j.clnu.2012.08.011 · Cited by 552 · see citing works
The effectiveness of clinical guideline implementation strategies – a synthesis of systematic review findings
Prior, M., Guerin, M., & Grimmer, K. A. (2008) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2008.01014.x · Cited by 509 · see citing works
Continuing education meetings and workshops: effects on professional practice and health care outcomes
Forsetlund, L., Bjørndal, A., Rashidian, A., Jamtvedt, G., O'Brien, M. A., Wolf, F. M., Davis, D., Odgaard-Jensen, J., & Oxman, A. D. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003030.pub2 · Cited by 1,849 · see citing works
Self-citation
External Incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients With Chronic Diseases
Casalino, L. P., Gillies, R. R., Shortell, S. M., Schmittdiel, J. A., Bodenheimer, T. S., Robinson, J. C., Rundall, T. G., Oswald, N., Schauffler, H. H., & Wang, M. C. (2003) · JAMA · doi:10.1001/jama.289.4.434 · Cited by 473 · see citing works
Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS ® ) Society Recommendations
Lassen, K., Coolsen, M. M. E., Slim, K., Carli, F., de Aguilar‐Nascimento, J. E., Schäfer, M., Parks, R. W., Fearon, K. C. H., Lobo, D. N., Demartines, N., et al. (2012) · World Journal of Surgery · doi:10.1007/s00268-012-1771-1 · Cited by 473 · see citing works
“There are also indications that audit per se improves clinical results through feedback [187].”
Background
How can we improve guideline use? A conceptual framework of implementability
Gagliardi, A. R., Brouwers, M. C., Palda, V. A., Lemieux‐Charles, L., & Grimshaw, J. (2011) · Implementation Science · doi:10.1186/1748-5908-6-26 · Cited by 469 · see citing works
Are multifaceted interventions more effective than single-component interventions in changing health-care professionals' behaviours? An overview of systematic reviews
Squires, J. E., Sullivan, K., Eccles, M. P., Worswick, J., & Grimshaw, J. M. (2014) · Implementation Science · doi:10.1186/s13012-014-0152-6 · Cited by 368 · see citing works
“9/23 reviews reported findings consistent with both single-component and multifaceted interventions being generally effective compared to controls [7,8,18,20,22,24,28-30]”
BackgroundResultInfluential
Audit and feedback and clinical practice guideline adherence: Making feedback actionable
Hysong, S. J., Best, R. G., & Pugh, J. A. (2006) · Implementation Science · doi:10.1186/1748-5908-1-9 · Cited by 371 · see citing works
“Along similar lines, Jamtvedt and colleagues [6] reported a median adjusted relative risk of non-compliance of .”
Background
The effectiveness of self-assessment on the identification of learner needs, learner activity, and impact on clinical practice: BEME Guide no. 10
Colthart, I., Bagnall, G., Evans, A., Allbutt, H., Haig, A., Illing, J. C., & McKinstry, B. (2008) · Medical Teacher · doi:10.1080/01421590701881699 · Cited by 385 · see citing works
Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update
Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L. R., Nyquist, A., Saiman, L. M., Yokoe, D. S., Maragakis, L. L., et al. (2014) · Infection Control and Hospital Epidemiology · doi:10.1017/s0899823x00193869 · Cited by 371 · see citing works
Systematic review of knowledge translation strategies in the allied health professions
Scott, S. D., Albrecht, L., O’Leary, K., Ball, G. D., Hartling, L., Hofmeyer, A., Jones, C. A., Klassen, T. P., Burns, K. K., Newton, A. S., et al. (2012) · Implementation Science · doi:10.1186/1748-5908-7-70 · Cited by 331 · see citing works
Interventions targeted at women to encourage the uptake of cervical screening
Everett, T., Bryant, A., Griffin, M. F., Martin-Hirsch, P. P., Forbes, C. A., & Jepson, R. G. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002834.pub2 · Cited by 332 · see citing works
Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update
Calderwood, M. S., Anderson, D. J., Bratzler, D. W., Dellinger, E. P., Garcia‐Houchins, S., Maragakis, L. L., Nyquist, A., Perkins, K. M., Preas, M. A., Saiman, L. M., et al. (2023) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2023.67 · Cited by 328 · see citing works
Meta-Analysis: Audit and Feedback Features Impact Effectiveness on Care Quality
Hysong, S. J. (2009) · Medical Care · doi:10.1097/mlr.0b013e3181893f6b · Cited by 306 · see citing works
“Kluger and DeNisi proposed that 3 factors determine how effectively this attentional shift occurs: (1) characteristics of the feedback itself (these can be content or format related), (2) the nature of the task performed, and (3) situational and personality variables.”
BackgroundInfluential
Infection control measures to limit the spread of Clostridium difficile
Vonberg, R., Kuijper, E. J., Wilcox, M. H., Barbut, F., Tüll, P., Gastmeier, P., van den Broek, P. J., Colville, A., Coignard, B., Daha, T., et al. (2008) · Clinical Microbiology and Infection · doi:10.1111/j.1469-0691.2008.01992.x · Cited by 312 · see citing works
Peripheral venous catheters: an under-evaluated problem
Zingg, W., & Pittet, D. (2009) · International Journal of Antimicrobial Agents · doi:10.1016/s0924-8579(09)70565-5 · Cited by 312 · see citing works
Physician Awareness of Drug Cost: A Systematic Review
Allan, G. M., Lexchin, J., & Wiebe, N. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040283 · Cited by 292 · see citing works
A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions
Powell, B. J., Proctor, E. K., & Glass, J. E. (2014) · Research on Social Work Practice · doi:10.1177/1049731513505778 · Cited by 268 · see citing works
Knowledge Translation: Closing the Evidence-to-Practice Gap
Lang, E., Wyer, P. C., & Haynes, R. B. (2006) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2006.08.022 · Cited by 281 · see citing works
Barriers to Primary Care Clinician Adherence to Clinical Guidelines for the Management of Low Back Pain: A Systematic Review and Metasynthesis of Qualitative Studies
Slade, S. C., Kent, P., Patel, S., Bucknall, T., & Buchbinder, R. (2016) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000324 · Cited by 261 · see citing works
Use of process measures to monitor the quality of clinical practice
Lilford, R. J., Brown, C., & Nicholl, J. P. (2007) · BMJ · doi:10.1136/bmj.39317.641296.ad · Cited by 269 · see citing works
Factors Associated With Decisions to Undergo Surgery Among Patients With Newly Diagnosed Early-Stage Lung Cancer
Cykert, S. (2010) · JAMA · doi:10.1001/jama.2010.793 · Cited by 268 · see citing works
What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review
Foy, R., Eccles, M., Jamtvedt, G., Young, J., Grimshaw, J., & Baker, R. (2005) · BMC Health Services Research · doi:10.1186/1472-6963-5-50 · Cited by 250 · see citing works
Self-citation
Quality of care for maternal and newborn health: the neglected agenda
van den Broek, N., & Graham, W. (2009) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2009.02333.x · Cited by 239 · see citing works
Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests
the Canada PRIME Plus Team, Patey, A. M., Islam, R., Francis, J. J., Bryson, G. L., & Grimshaw, J. M. (2012) · Implementation Science · doi:10.1186/1748-5908-7-52 · Cited by 237 · see citing works
Non-clinical interventions for reducing unnecessary caesarean section
Khunpradit, S., Tavender, E. J., Lumbiganon, P., Laopaiboon, M., Wasiak, J., & Gruen, R. L. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005528.pub2 · Cited by 236 · see citing works
Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care
Greenhalgh, J., Dalkin, S. M., Gooding, K., Gibbons, E. J., Wright, J. M., Meads, D. M., Black, N. A., Valderas, J. M., & Pawson, R. (2017) · Health Services and Delivery Research · doi:10.3310/hsdr05020 · Cited by 238 · see citing works
“Audit and feedback Patient-reported outcome measures feedback is an example of an audit and feedback intervention, as it involves generating a ‘summary of clinical performance of health care over a specified period of time aimed at providing information to health professionals to allow them to assess and adjust their…”
BackgroundMethod
Using theory to synthesise evidence from behaviour change interventions: The example of audit and feedback
Gardner, B., Whittington, C., McAteer, J., Eccles, M. P., & Michie, S. (2010) · Social Science & Medicine · doi:10.1016/j.socscimed.2010.01.039 · Cited by 225 · see citing works
Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? A systematic review
Boyce, M., & Browne, J. P. (2013) · Quality of Life Research · doi:10.1007/s11136-013-0390-0 · Cited by 228 · see citing works
Helping Babies Breathe: Global neonatal resuscitation program development and formative educational evaluation
Singhal, N., Lockyer, J., Fidler, H., Keenan, W., Little, G. A., Bucher, S., Qadir, M., & Niermeyer, S. (2011) · Resuscitation · doi:10.1016/j.resuscitation.2011.07.010 · Cited by 226 · see citing works
ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group
Chan, W., Pearson, T. A., Bennett, G. C., Cushman, W. C., Gaziano, T. A., Gorman, P., Handler, J., Krumholz, H. M., Kushner, R. F., MacKenzie, T. D., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.11.004 · Cited by 218 · see citing works
“Organizational Culture Multidisciplinary teams, coordination of care, pace of change, a blame-free culture, and a history of quality improvement (9,19,28,38) Low-baseline adherence (19,29,34,38,40,46,55)”
Effectiveness of Decision Support for Families, Clinicians, or Both on HPV Vaccine Receipt
Fiks, A. G., Grundmeier, R. W., Mayne, S. L., Song, L., Feemster, K. A., Karavite, D., Hughes, C. C., Massey, J., Keren, R., Bell, L. M., et al. (2013) · PEDIATRICS · doi:10.1542/peds.2012-3122 · Cited by 215 · see citing works
Taking healthcare interventions from trial to practice
Glasziou, P., Chalmers, I., Altman, D. G., Bastian, H., Boutron, I., Brice, A., Jamtvedt, G., Farmer, A., Ghersi, D., Groves, T., et al. (2010) · BMJ · doi:10.1136/bmj.c3852 · Cited by 209 · see citing works
Self-citation
A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis
Egerton, T., Diamond, L. E., Buchbinder, R., Bennell, K. L., & Slade, S. C. (2017) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2016.12.002 · Cited by 205 · see citing works
Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews
Lewin, S. A., Lavis, J. N., Oxman, A. D., Gabriel Bastías, S., Chopra, M., Ciapponi, A., Flottorp, S. A., Martí, S. G., Tomás Pantoja, C., Gabriel Rada, G., et al. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61403-8 · Cited by 195 · see citing works
Self-citation
The patient's role in the spread and control of bacterial resistance to antibiotics
Davey, P. G., Pagliari, C., & HAYES, A. (2002) · Clinical Microbiology and Infection · doi:10.1046/j.1469-0691.8.s.2.6.x · Cited by 192 · see citing works
Successful use of feedback to improve antibiotic prescribing and reduce Clostridium difficile infection: a controlled interrupted time series
Fowler, S., Webber, A., Cooper, B. S., Phimister, A., Price, K., Carter, Y., Kibbler, C. C., Simpson, A. J. H., & Stone, S. P. (2007) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkm014 · Cited by 186 · see citing works
Local opinion leaders: effects on professional practice and health care outcomes
Flodgren, G., Parmelli, E., Doumit, G. D., Gattellari, M., O’Brien, M. A., Grimshaw, J., & Eccles, M. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000125.pub3 · Cited by 191 · see citing works
Self-citation
Documenting Rapid Response System afferent limb failure and associated patient outcomes
Trinkle, R. M., & Flabouris, A. (2011) · Resuscitation · doi:10.1016/j.resuscitation.2011.03.019 · Cited by 181 · see citing works
Moving From Discovery to System-Wide Change: The Role of Research in a Learning Health Care System: Experience from Three Decades of Health Systems Research in the Veterans Health Administration
Atkins, D., Kilbourne, A. M., & Shulkin, D. J. (2017) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031816-044255 · Cited by 183 · see citing works
“…provider training, ongoing technical assistance (Kilbourne et al. 2014, 2015) Audit + feedback Remote electronic extraction of local quality performance and provide feedback (Jamtvedt et al. 2006, Ivers et al. 2012) Figure 2 Examples of implementation strategies used by VA QUERI programs.”
Method
Enhancing the role of case-oriented peer review to improve quality and safety in radiation oncology: Executive summary
Marks, L. B., Adams, R., Pawlicki, T. A., Blumberg, A. L., Hoopes, D. J., Brundage, M., & Fraass, B. A. (2013) · Practical Radiation Oncology · doi:10.1016/j.prro.2012.11.010 · Cited by 179 · see citing works
“#Simplified Radiation Therapy Process Steps: (1) Consultation/decision to treat -> (2) Simulation/imaging/immobilization -> (3) Anatomical model definition ->”
Interventions to improve hand hygiene compliance in patient care
Gould, D. J., Moralejo, D. G., Drey, N., & Chudleigh, J. H. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005186.pub3 · Cited by 175 · see citing works
Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations
Ketelaar, N. A. B. M., Faber, M. J., Flottorp, S. A., Rygh, L. H., Deane, K. H., & Eccles, M. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004538.pub2 · Cited by 171 · see citing works
The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review
Hill, J. E., Stephani, A.-M., Sapple, P., & Clegg, A. J. (2020) · Implementation Science · doi:10.1186/s13012-020-0975-2 · Cited by 168 · see citing works
“This may reflect their frequent adaptation during implementation and that details of the approach were often incompletely reported [22, 26, 32].”
BackgroundMethodResultInfluential
The Feedback Intervention Trial (FIT) — Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial
Fuller, C., Michie, S., Savage, J., McAteer, J., Besser, S. J., Charlett, A., Hayward, A. C., Cookson, B., Cooper, B. S., Duckworth, G. J., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0041617 · Cited by 175 · see citing works
“Our results are consistent with systematic reviews [14,15] of 61 randomised controlled trials of the effectiveness of audit and feedback on healthcare practices other than hand-hygiene.”
BackgroundResult
Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials
Forsetlund, L., Eike, M. C., Gjerberg, E., & Vist, G. E. (2011) · BMC Geriatrics · doi:10.1186/1471-2318-11-16 · Cited by 165 · see citing works
“Similarly, a previous systematic review of audit and feedback interventions concluded that the effect was probably greater the more intensive the feedback [35].”
Result
Strategies for improving the quality of health care in maternal and child health in low‐ and middle‐income countries: an overview of systematic reviews
Althabe, F., Bergel, E. F., Cafferata, M. L., Gibbons, L., Ciapponi, A., Alemán, A., Colantonio, L. D., & Palacios, A. R. (2008) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2007.00912.x · Cited by 158 · see citing works
Interventions for promoting information and communication technologies adoption in healthcare professionals
Gagnon, M.-P., Légaré, F., Labrecque, M., Frémont, P., Pluye, P., Gagnon, J., Car, J., Pagliari, C., Desmartis, M., Turcot, L., et al. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006093.pub2 · Cited by 157 · see citing works
Interventions to optimise prescribing in care homes: systematic review
Fahrni, M. L., Singh, S., Franklin, B. D., Bottle, A., & Majeed, A. (2011) · Age and Ageing · doi:10.1093/ageing/afq161 · Cited by 156 · see citing works
Interventions to improve the use of systematic reviews in decision-making by health system managers, policy makers and clinicians
Murthy, L., Shepperd, S., Clarke, M. J., Garner, S. E., Lavis, J. N., Perrier, L., Roberts, N. W., & Straus, S. E. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009401.pub2 · Cited by 155 · see citing works
Variables that affect the process and outcome of feedback, relevant for medical training: a meta‐review
van de Ridder, J. M. M., McGaghie, W. C., Stokking, K. M., & ten Cate, O. T. J. (2015) · Medical Education · doi:10.1111/medu.12744 · Cited by 154 · see citing works
What are the most effective strategies for improving quality and safety of health care?
Scott, I. (2009) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2008.01798.x · Cited by 153 · see citing works
The role of theory in research to develop and evaluate the implementation of patient safety practices: Figure 1
Foy, R., Ovretveit, J., Shekelle, P. G., Pronovost, P. J., Taylor, S. L., Dy, S., Hempel, S., McDonald, K. M., Rubenstein, L. V., & Wachter, R. M. (2011) · BMJ Quality & Safety · doi:10.1136/bmjqs.2010.047993 · Cited by 148 · see citing works
“For example, audit and feedback are variably effective in changing provider behaviour and clinical outcomes.(6) Their effectiveness may vary according to features”
Background
Multifaceted strategies may increase implementation of physiotherapy clinical guidelines: a systematic review
van der Wees, P. J., Jamtvedt, G., Rebbeck, T. J., de Bie, R. A., Dekker, J., & Hendriks, E. (2008) · Australian Journal of Physiotherapy · doi:10.1016/s0004-9514(08)70002-3 · Cited by 145 · see citing works
Self-citation
Advancing the Responsible Use of Medicines: Applying Levers for ChangePreprint
Aitken, M. L., & Gorokhovich, L. (2013) · SSRN Electronic Journal · doi:10.2139/ssrn.2222541 · Cited by 147 · see citing works
Development of an Enhanced Recovery After Surgery Guideline and Implementation Strategy Based on the Knowledge-to-action Cycle
McLeod, R. S., Aarts, M.-A. W., Chung, F. F., Eskicioglu, C., Forbes, S. S., Conn, L. G., McCluskey, S. A., McKenzie, M., Morningstar, B., Nadler, A., et al. (2015) · Annals of Surgery · doi:10.1097/sla.0000000000001067 · Cited by 139 · see citing works
Interventions to Increase Recommendation and Delivery of Screening for Breast, Cervical, and Colorectal Cancers by Healthcare Providers
Sabatino, S. A., Habarta, N., Baron, R. C., Coates, R. J., Rimer, B. K., Kerner, J. F., Coughlin, S. S., Kalra, G. P., & Chattopadhyay, S. K. (2008) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2008.04.008 · Cited by 137 · see citing works
Strategies to increase the delivery of smoking cessation treatments in primary care settings: A systematic review and meta-analysis
Papadakis, S., McDonald, P., Mullen, K., Reid, R. D., Skulsky, K., & Pipe, A. (2010) · Preventive Medicine · doi:10.1016/j.ypmed.2010.06.007 · Cited by 135 · see citing works
Better Interprofessional Teamwork, Higher Level of Organized Care, and Lower Risk of Burnout in Acute Health Care Teams Using Care Pathways
Deneckere, S., Euwema, M., Lodewijckx, C., Panella, M., Mutsvari, T., Sermeus, W., & Vanhaecht, K. (2012) · Medical Care · doi:10.1097/mlr.0b013e3182763312 · Cited by 135 · see citing works
“A preintervention audit of the control group would have initiated a learning effect within the teams that potentially could have biased the results.(50) Fourth, although our intervention with its 3 building blocks was fully standardized, some variation was present in the actual inclusion of the KIs in the CPs.”
Result
Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition
Chopra, M., Sharkey, A., Dalmiya, N., Anthony, D., & BINKIN, N. J. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61423-8 · Cited by 128 · see citing works
Building theories of knowledge translation interventions: Use the entire menu of constructs
Brehaut, J. C., & Eva, K. W. (2012) · Implementation Science · doi:10.1186/1748-5908-7-114 · Cited by 120 · see citing works
Infection risks associated with peripheral vascular catheters
Zhang, L., Cao, S., Marsh, N. M., Ray‐Barruel, G., Flynn, J. M., Larsen, E. N., & Rickard, C. M. (2016) · Journal of Infection Prevention · doi:10.1177/1757177416655472 · Cited by 125 · see citing works
“There is unequivocal evidence that performance feedback contributes to improved professional practices and better healthcare outcomes (Frampton et al., 2014; Jamtvedt et al., 2006).”
Background
Effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour or patient outcomes
Flodgren, G., Pomey, M., Taber, S., & Eccles, M. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008992.pub2 · Cited by 125 · see citing works
Clinical performance comparators in audit and feedback: a review of theory and evidence
Gude, W. T., Brown, B. C., van der Veer, S. N., Colquhoun, H. L., Ivers, N. M., Brehaut, J., Landis‐Lewis, Z., Armitage, C. J., de Keizer, N. F., & Peek, N. B. (2019) · Implementation Science · doi:10.1186/s13012-019-0887-1 · Cited by 123 · see citing works
“[92] (118 trials), Hysong [93] found no effect of adding benchmarks to A&F, regardless of whether or not identities of peers were known to recipients.”
Factors Influencing Prescribing Decisions of Physicians: A Review
Davari, M., Khorasani, E., & Tigabu, B. M. (1970) · Ethiopian Journal of Health Sciences · doi:10.4314/ejhs.v28i6.15 · Cited by 124 · see citing works
“Furthermore, feedback on the prescribing behavior based on agreed and reflected criteria improves the prescribing behavior more than mere distribution of guidelines (32,59,60).”
Background
Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity
Pattinson, R., Say, L., Makin, J. D., & Bastos, M. H. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002961.pub2 · Cited by 124 · see citing works
Making It Happen: Training health-care providers in emergency obstetric and newborn care
Ameh, C., & van den Broek, N. R. (2015) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2015.03.019 · Cited by 120 · see citing works
From Tasks To Processes: The Case For Changing Health Information Technology To Improve Health Care
Walker, J. M., & Carayon, P. (2009) · Health Affairs · doi:10.1377/hlthaff.28.2.467 · Cited by 122 · see citing works
Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)
Clyne, B., Smith, S. M., Hughes, C. M., Boland, F., Bradley, M. C., Cooper, J. A., Fahey, T. P., & on behalf of the OPTI-SCRIPT study team (2015) · The Annals of Family Medicine · doi:10.1370/afm.1838 · Cited by 118 · see citing works
“21,22,23 In anticipation of this, anonymised data from the Primary Care Reimbursement Service (PCRS) pharmacy claims database of dispensed medications (national prescribing database of GP and pharmacy claims) 24 PIP was assessed using 28 criteria included in this study, 16 (six of the PIP criteria…”
Method
Can we improve adenoma detection rates? A systematic review of intervention studies
Corley, D. A., Jensen, C. D., & Marks, A. R. (2011) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2011.04.017 · Cited by 120 · see citing works
Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial
Dumont, A., Fournier, P., Abrahamowicz, M., Traoré, M., Haddad, S., & Fraser, W. D. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60593-0 · Cited by 140 · see citing works
Have we improved use of medicines in developing and transitional countries and do we know how to? Two decades of evidence
Holloway, K., Ivanovska, V., Wagner, A. K., Vialle-Valentin, C. E., & Ross‐Degnan, D. (2013) · Tropical Medicine & International Health · doi:10.1111/tmi.12123 · Cited by 117 · see citing works
“This may reflect poorer baseline adherence to desired prescribing practices or poorer health infrastructure in developing than developed countries (Jamtvedt et al. 2006).”
Background
Pediatrician Perceptions of an Outpatient Antimicrobial Stewardship Intervention
Szymczak, J. E., Feemster, K. A., Zaoutis, T. E., & Gerber, J. S. (2014) · Infection Control and Hospital Epidemiology · doi:10.1086/677826 · Cited by 117 · see citing works
Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices
Friedberg, M. W., Safran, D. G., Coltin, K. L., Dresser, M., & Schneider, E. C. (2008) · Journal of General Internal Medicine · doi:10.1007/s11606-008-0856-x · Cited by 116 · see citing works
Does Faculty Development Enhance Teaching Effectiveness?
Hendricson, W. D., Anderson, E. L., Andrieu, S. C., Chadwick, D. G., Cole, J. R., George, M. C., Glickman, G. N., Glover, J. F., Goldberg, J. S., Haden, N. K., et al. (2007) · Journal of Dental Education · doi:10.1002/j.0022-0337.2007.71.12.tb04428.x · Cited by 118 · see citing works
Model depicting aspects of audit and feedback that impact physicians’ acceptance of clinical performance feedback
Payne, V. L., & Hysong, S. J. (2016) · BMC Health Services Research · doi:10.1186/s12913-016-1486-3 · Cited by 114 · see citing works
Impact of organisation and management factors on infection control in hospitals: a scoping review
Griffiths, P., Renz, A., Hughes, J., & Rafferty, A. M. (2009) · Journal of Hospital Infection · doi:10.1016/j.jhin.2009.05.003 · Cited by 115 · see citing works
Patterns of research utilization on patient care units
Estabrooks, C. A., Scott, S. D., Squires, J. E., Stevens, B., O’Brien‐Pallas, L., Watt‐Watson, J., Profetto‐McGrath, J., McGilton, K. S., Golden‐Biddle, K., Lander, J., et al. (2008) · Implementation Science · doi:10.1186/1748-5908-3-31 · Cited by 112 · see citing works
“…a feedback mechanism, where data is fed back to a unit's providers in the form of some kind of report, is one of the most commonly applied evaluation mechanisms used in healthcare to implement the adoption of research-based practices, and has been shown to have modest effects with physicians [56].”
What is quality in maternal and neonatal health care?
Raven, J., Tolhurst, R., Tang, S., & van den Broek, N. R. (2011) · Midwifery · doi:10.1016/j.midw.2011.09.003 · Cited by 114 · see citing works
An International prevalence measurement of care problems: study protocol
van Nie‐Visser, N. C., Schols, J. M. G. A., Meesterberends, E., Lohrmann, C., Meijers, J. M. M., & Halfens, R. J. G. (2013) · Journal of Advanced Nursing · doi:10.1111/jan.12190 · Cited by 110 · see citing works
Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa
Bergh, A., Kerber, K. J., Abwao, S., Johnson, J. D.-G., Aliganyira, P., Davy, K., Gamache, N., Kanté, M., Ligowe, R., Luhanga, R., et al. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-293 · Cited by 107 · see citing works
Heterogeneity of Treatment Effects: Implications for Guidelines, Payment, and Quality Assessment
Greenfield, S., Kravitz, R. L., Duan, N., & Kaplan, S. H. (2007) · The American Journal of Medicine · doi:10.1016/j.amjmed.2007.02.002 · Cited by 105 · see citing works
Carbapenem-ResistantEnterobacteriaceae: A Strategic Roadmap for Infection Control
Friedman, N. D., Carmeli, Y., Walton, A. L., & Schwaber, M. J. (2017) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2017.42 · Cited by 101 · see citing works
“Verbal and written feedback, ideally including explicit targets and action plans, are valuable.(147) Local antibiotic treatment guidelines should include recommendations for treatment of proven and suspected infections caused by CRE.”
Background
Physician awareness of diagnostic and nondrug therapeutic costs: A systematic review
Allan, G. M., & Lexchin, J. (2008) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462308080227 · Cited by 101 · see citing works
Giving Feedback on Clinical Skills: Are We Starving Our Young?
Anderson, P. (2012) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-11-000295.1 · Cited by 100 · see citing works
External inspection of compliance with standards for improved healthcare outcomes
Flodgren, G., Gonçalves, D. C., & Pomey, M. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008992.pub3 · Cited by 100 · see citing works

Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback
Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O'Brien, M. A., & Oxman, A. D. (2006) · BMJ Quality & Safety · doi:10.1136/qshc.2006.018549 · Cited by 364 · see citing works
Self-citation
Audit and feedback had small but potentially important improvements in professional practice
Hurst, D. (2013) · Evidence-Based Dentistry · doi:10.1038/sj.ebd.6400910 · Cited by 15 · see citing works
Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes (Withdrawn Paper. 1998, art no. CD000260)
O'Brien, M., Ad, O., Davis, D. A., Haynes, R. B., Freemantle, N., & Harvey, E. (2005) · UCL Discovery (University College London) · Cited by 68 · see citing works
Self-citation
Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes
O’Brien, M. A., Oxman, A. D., Davis, D., Haynes, R. B., Freemantle, N., & Harvey, E. (1998) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000260 · Cited by 123 · see citing works
Self-citation
Retracted
Audit and feedback versus alternative strategies: Effects on professional practice and health care outcomes (Cochrane review)
(2001) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.1340210210 · Cited by 17 · see citing works

Authors: Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O'Brien, M. A., & Oxman, A. D.
Affiliations: Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
ORCID: Jamtvedt, Gro
Young, Jane M
Kristoffersen, Doris Tove
Oxman, Andrew D
Venue: Cochrane Database of Systematic Reviews
Publisher: John Wiley & Sons, Ltd
Published: 2006-04-19
Issue: 2
Pages: CD000259-CD000259
ISSN: 1361-6137 (ISSN-L)
DOI: 10.1002/14651858.cd000259.pub2
OpenAlex: W4245034287
Cited by: 912
References: 207
Citations by year: 2026: 4 · 2025: 8 · 2024: 10 · 2023: 23 · 2022: 13 · 2021: 27 · 2020: 23 · 2019: 18 · 2018: 31 · 2017: 42 · 2016: 38 · 2015: 55 · 2014: 45 · 2013: 133 · 2012: 82
Type: reference entry
Language: en
Update notices: new_version (2012-06-13)
Open access: closed
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords: audit and feedback, professional practice change, guideline adherence, health care outcomes, multicomponent intervention, educational meetings, intervention intensity, behavior change, quality improvement, patient outcomes, healthcare workers, meta-regression, study quality, risk difference, relative risk, continuous outcomes, binary outcomes
MeSH terms: Education, Medical, Continuing, Health Personnel, Health Services Research, Humans, Medical Audit, Practice Patterns, Physicians', Professional Practice, Outcome Assessment, Health Care, Feedback, Psychological

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

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