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

The DOI matches its Crossref record; 204 of the 207 references it cites were found in a registry or an index.

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
Open this paper in CoChat — free account

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.

Overview

Integrity signals

Registry

Crossref · 10.1002/14651858.cd000259.pub2

Cites

204 of 204 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

1 retracted

Show all 207 references

Research works printed but not linked: 24

  1. Baker, 2003, Randomised controlled trial of the impact of guidelines, prioritised review criteria and feedback on implementation of recommendations for angina and asthma., British Journal of General Practice, 53, 284
  2. Boekeloo, 1990, Strategies for increasing house staff management of cholesterol with inpatients, American Journal of Preventive Medicine, 6, 51
  3. Goff, 2002, Enchancing the quality of care for patients with coronary heart disease: The design and baseline results of the hastening the effective application of research through technology (HEART) trial., American Journal of Managed Care, 8, 1069
  4. Hemminiki, 1992, Need for and influence or feedback from the Finnish birth register to data providers, Quality Assurance in Health Care, 4, 133
  5. Henderson, 1979, Hospital cost containment: a little knowledge helps, Clinical Research, 27, 297A
  6. Howe, 1996, Detecting psychological distress: can general practitioners improve their performance?, British Journal of General Practice, 46, 407
  7. Roski, 1998, Changing practice patterns as a result of implementing the Agency for Health Care Policy and Research guidelines in 20 primary care clinics, Tobacco Control, 7 Suppl, S19-20; discuss
  8. van den Hombergh Practice visits. Assessing and improving management in general practice Thesis, University of Nijmegen 1998
  9. Veninga N Improving prescribing in general practice Thesis, Rijksuiversiteit Groningen 2000 · DOI
  10. Ward, 1996, Educational feedback in management of diabetes in general practice, Education for General Practice, 7, 142
  11. Brown, 1988, Evaluation of a continuing medical education program for primary care physcicians on the management of alcoholism, Journal of Medical Education, 63, 482
  12. Everett, 1983, Effect of cost education, cost audits, and faculty chart review on the use of laboratory services, Archives of Internal Medicine, 143, 942, 10.1001/archinte.1983.00350050100019 · DOI
  13. Gerbert, 1988, Changing dentists' knowledge, attitudes and behaviours relating to AIDS: a controlled educational intervention, JADA, 116, 851
  14. Grimshaw J Evaluation of four quality assurance initiatives to improve out-patient referrals from general practice to hospital Thesis, University of Aberdeen 1998
  15. Putnam, 1985, Impact of patient care appraisal on physicians behaviour in the office setting, Canadian Medical Association Journal, 132, 1025
  16. Taylor, 1997, Changes in prescribing following a pharmicists-led audit of ulcer-healing therapy in general practice, The Pharmaceutical Journal, 259, R6
  17. Bandura, 1986, Social foundations of thought and action: a social cognitive theory
  18. Davis, 1991, The Research and Development of Resource Base in CME. An Annotated Bibliography and Literature Searching Service. Annual Report
  19. Freemantle, 2003, Printed educational materials: effects on professional practice and health care outcomes (Cochrane Review), Cochrane Database of Systematic Reviews
  20. Goff, 2002, Enchancing the quality of care for patients with coronary heart disease: The design and baseline results of the hastening the effective application of research through technology (HEART) trial, The American Journal of Managed Care, 8, 1069
  21. Goff, 2003, Quality of care for secondary prevention for patients with coronary heart disease: Results of the hastening the effective application of research through technology (HEART) trial, Heart Journal, 146, 1045, 10.1016/S0002-8703(03)00522-2 · DOI
  22. Green, 1988, Preventive practices by physicians: behavioural determinants and potential interventions, The American Journal of Preventive Medicine, 4, 101
  23. Oxman, 2001, An overview of strategies to promote implementation of evidence based health care, 101
  24. Thomson MA A systematic review of three interventions to improve health professional practice Unpublished Master’s Thesis, McMaster University, Hamilton, Canada 1995

Cited by

Sorted by citations

Related

See all

Metadata

Authors
Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O'Brien, M. A., & Oxman, A. D.
Affiliations
Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
ORCID
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

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review