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

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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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Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes
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BackgroundMethodResultInfluential
Effectiveness of interventions to improve the detection and treatment of osteoporosis in primary care settings: a systematic review and meta-analysis
Laliberté, M.-C., Perreault, S., Jouini, G., Shea, B., & Lalonde, L. (2011) · Osteoporosis International · doi:10.1007/s00198-011-1557-6 · Cited by 40
Prevalence, outcome and quality of care among children hospitalized with severe acute malnutrition in Kenyan hospitals: A multi-site observational study
Gachau, S., Irimu, G., Ayieko, P., Akech, S., Agweyu, A., & English, M. (2018) · PLoS ONE · doi:10.1371/journal.pone.0197607 · Cited by 40
Has the COVID 19 Virus Changed Adherence to Hand Washing among Healthcare Workers?
Ragusa, R., Marranzano, M., Lombardo, A., Quattrocchi, R., Bellia, M. A., & Lupo, L. (2021) · Behavioral Sciences · doi:10.3390/bs11040053 · Cited by 40
“Audit and feedback are widely used as a quality improvement tool, based on the belief that professionals are prompted to modify their practice when performance feedback is given [16].”
Background
Health workers’ perceptions of obstetric critical incident audit in Thyolo District, Malawi
Bakker, W., van den Akker, T., Mwagomba, B. M., Khukulu, R., van Elteren, M., & van Roosmalen, J. (2011) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2011.02832.x · Cited by 40
“The acceptance of audit by health workers is thought to be an important determinant of its success: benefits are likely to be larger when staff recognize the importance of peer review for their professional development and for the quality of care (Jamtvedt et al. 2006; Pattinson et al. 2005).”
Background
A review of cost‐effectiveness, cost‐containment and economics curricula in graduate medical education
Varkey, P., Murad, M. H., Braun, C., Grall, K., & Saoji, V. (2010) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2009.01249.x · Cited by 39
Gianotti-Crosti Syndrome, Pityriasis Rosea, Asymmetrical Periflexural Exanthem, Unilateral Mediothoracic Exanthem, Eruptive Pseudoangiomatosis and Papular-Purpuric Gloves and Socks Syndrome: A Brief Review and Arguments for Diagnostic Criteria
Chuh, A. A. T., Zawar, V. P., Law, M., & Sciallis, G. F. (2012) · Infectious Disease Reports · doi:10.4081/idr.2012.e12 · Cited by 39
Implementation and first results of a mandatory, nationwide audit on liver surgery
van der Werf, L. R., Kok, N. F. M., Buis, C. I., Grünhagen, D. J., Hoogwater, F. J. H., Swijnenburg, R., den Dulk, M., Dejong, K., Klaase, J. M., de Boer, M. T., et al. (2019) · HPB · doi:10.1016/j.hpb.2019.02.021 · Cited by 39
Decreasing time trend in SSI incidence for orthopaedic procedures: surveillance matters!
Skråmm, I., Benth, J. Š., & Bukholm, G. (2012) · Journal of Hospital Infection · doi:10.1016/j.jhin.2012.08.011 · Cited by 39
Developing a complex intervention to improve prescribing safety in primary care: mixed methods feasibility and optimisation pilot study
Grant, A. M., Guthrie, B., & Dreischulte, T. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-004153 · Cited by 32
“Disease coding error (2) CHADS2 score judged to underestimate risk (17) Secondary care decision”
Background
Sustained reductions in urinary catheter use over 5 years: Bedside nurses view themselves responsible for evaluation of catheter necessity
Fakih, M. G., Rey, J. E., Pena, M. E., Szpunar, S. M., & Saravolatz, L. D. (2012) · American Journal of Infection Control · doi:10.1016/j.ajic.2012.04.328 · Cited by 38
Quality monitoring in thyroid surgery using the Shewhart control chart
Duclos, A., Touzet, S., Soardo, P., Colin, C., Peix, J.-L., & Lifante, J. C. (2009) · British journal of surgery · doi:10.1002/bjs.6418 · Cited by 38
Interventions in primary care to improve cardiovascular risk factors and glycated haemoglobin (HbA1c) levels in patients with diabetes: a systematic review
Seitz, P., Rosemann, T. J., Gensichen, J., & Huber, C. A. (2010) · Diabetes Obesity and Metabolism · doi:10.1111/j.1463-1326.2010.01347.x · Cited by 38
“Furthermore, and as reported in previous studies, the present review showed that interventions providing feedback to general practioners (GPs) on their clinical performance [99], forming multidisciplinary clinical teams [16] and providing patient education [100] seemed to be the most successful approaches.”
Result
Increasing hospital-wide delivery of smoking cessation care for nicotine-dependent in-patients: a multi-strategic intervention trial.
Freund, M., Campbell, E., Paul, C., Sakrouge, R., Lecathelinais, C., Knight, J., Wiggers, J., Walsh, R., Jones, T. C., Girgis, A., et al. (2009) · Addiction · doi:10.1111/j.1360-0443.2009.02520.x · Cited by 38
Evidence-based Peer Review for Radiation Therapy – Updated Review of the Literature with a Focus on Tumour Subsite and Treatment Modality
Huo, M., Gorayski, P., Poulsen, M. G., Thompson, K., & Pinkham, M. B. (2017) · Clinical Oncology · doi:10.1016/j.clon.2017.04.038 · Cited by 38
Closing the evidence‐practice gap for newborn pain using clinical networks
Spence, K., & Henderson-Smart, D. J. (2010) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.2010.01895.x · Cited by 37
Improvement in neonatal intensive care unit care: a cluster randomised controlled trial of active dissemination of information
Acolet, D., Allen, E., Houston, R., Wilkinson, A. R., Costeloe, K., & Elbourne, D. R. (2011) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2010.207522 · Cited by 40
Activating the knowledge-to-action cycle for geriatric care in India
Evans, J. M., Kiran, P. R., & Bhattacharyya, O. K. (2011) · Health Research Policy and Systems · doi:10.1186/1478-4505-9-42 · Cited by 37
Overview of interventions to enhance primary‐care provider management of patients with substance‐use disorders
Anderson, P. (2009) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2009.00113.x · Cited by 35
Improving adherence to hand hygiene among health care workers
Maskerine, C., & Loeb, M. B. (2006) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.77 · Cited by 36
A clinical audit in a multidisciplinary care path for thoracic surgery: An instrument for continuous quality improvement
Numan, R. C., Klomp, H. M., Li, W. W. L., Buitelaar, D. R., Burgers, J. A., van Sandick, J. W., & Wouters, M. W. J. M. (2012) · Lung Cancer · doi:10.1016/j.lungcan.2012.08.006 · Cited by 36
“It is advocated that a clinical audit could be an effective instrument for local quality improvement [3,4].”
Background
Implementing Clinical Practice Guidelines in occupational therapy practice: Recommendations from the research evidence
Stergiou‐Kita, M. (2010) · Australian Occupational Therapy Journal · doi:10.1111/j.1440-1630.2009.00842.x · Cited by 35
“…to complete statistical analysis Difficulty determining from data in base studies which barriers are most common and most likely to impede change Jamtvedt et al. (2006) Audit and feedback Can produce small to moderate improvements in professional practice Great variability in effects reported…”
Background
Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care: a cluster randomized trial (OPTI-SCRIPT study protocol)
Clyne, B., Bradley, M., Smith, S. M., Hughes, C., Motterlini, N., Clear, D., McDonnell, R., Williams, D. J., & Fahey, T. (2013) · Trials · doi:10.1186/1745-6215-14-72 · Cited by 35
“Feedback has been found to promote slight improvements in professional practice but is most effective when it is provided intensively [35,36].”
Background
Using audit and feedback to increase clinician adherence to clinical practice guidelines in brain injury rehabilitation: A before and after study
Jolliffe, L. J., Morarty, J., Hoffmann, T., Crotty, M., Hunter, P. C., Cameron, I. D., Li, X., & Lannin, N. A. (2019) · PLoS ONE · doi:10.1371/journal.pone.0213525 · Cited by 42
Audit filters for improving processes of care and clinical outcomes in trauma systems
Evans, C., Howes, D. W., Pickett, W., & Dagnone, L. E. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007590.pub2 · Cited by 35
A Randomized Effectiveness Trial of a Clinical Informatics Consult Service: Impact on Evidence-based Decision-making and Knowledge Implementation
Mulvaney, S. A., Bickman, L., Giuse, N. B., Lambert, E., Sathe, N. A., & Jerome, R. N. (2007) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2461 · Cited by 36
Quality indicators for cardiovascular primary care
Burge, F., Bower, K. N., Putnam, W., & Cox, J. L. (2007) · Canadian Journal of Cardiology · doi:10.1016/s0828-282x(07)70772-9 · Cited by 36
“There is some evidence that assessing the outcomes of the care we provide, as well as giving this information back to the providers (audit and feedback), has a positive impact on improving these outcomes (36).”
Background
Australian Clinical Guidelines for Acute Stroke Management 2007
Hill, K. M. (2008) · International Journal of Stroke · doi:10.1111/j.1747-4949.2008.00189.x · Cited by 36
Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice
Kavanagh, T., Stevens, B., Seers, K., Sidani, S., & Watt-Watson, J. (2010) · Implementation Science · doi:10.1186/1748-5908-5-90 · Cited by 35
Improving the fundamentals of care for older people in the acute hospital setting: facilitating practice improvement using a Knowledge Translation Toolkit
Wiechula, R., Kitson, A. A., Marcoionni, D., Page, T., Zeitz, K., & Silverston, H. (2009) · International Journal of Evidence-Based Healthcare · doi:10.1111/j.1744-1609.2009.00145.x · Cited by 34
Translating knowledge on best practice into improving quality of RRT care: a systematic review of implementation strategies
van der Veer, S. N., Jager, K. J., Nache, A., Richardson, D., Hegarty, J., Couchoud, C., de Keizer, N. F., & Tomson, C. (2011) · Kidney International · doi:10.1038/ki.2011.222 · Cited by 35
Educational Interventions for Implementation of Arthritis Clinical Practice Guidelines in Primary Care: Effects on Health Professional Behavior
Lineker, S. C., & Husted, J. (2010) · The Journal of Rheumatology · doi:10.3899/jrheum.100045 · Cited by 34
Impact of audit and feedback with action implementation toolbox on improving ICU pain management: cluster-randomised controlled trial
Roos-Blom, M.-J., Gude, W. T., de Jonge, E., Spijkstra, J. J., van der Veer, S. N., Peek, N. B., Dongelmans, D. A., & de Keizer, N. F. (2019) · BMJ Quality & Safety · doi:10.1136/bmjqs-2019-009588 · Cited by 36
The effect of electronic audits and feedback in primary care and factors that contribute to their effectiveness: a systematic review
den Bulck, S. V., Spitaels, D., Vaes, B., Goderis, G., Hermens, R., & Vankrunkelsven, P. (2020) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzaa128 · Cited by 35
Nurse Managers’ prerequisite for nursing development: a survey on pressure ulcers and contextual factors in hospital organizations
Gunningberg, L., Brudin, L. H., & Idvall, E. (2010) · Journal of Nursing Management · doi:10.1111/j.1365-2834.2010.01149.x · Cited by 35
The use of ‘academic detailing' to promote tobacco-use cessation counseling in dental offices
Albert, D. A., Ahluwalia, K. P., Ward, A., & Sadowsky, D. (2004) · The Journal of the American Dental Association · doi:10.14219/jada.archive.2004.0122 · Cited by 35
Improving Quality in Medicaid
Rittenhouse, D. R., & Robinson, J. C. (2005) · Medical Care · doi:10.1097/01.mlr.0000188992.48592.cd · Cited by 35
Estimating the Cost-Effectiveness of Quality-Improving Interventions in Oral Anticoagulation Management within General Practice
Claes, N., Moeremans, K., Buntinx, F., Jef, A., Jos, V., Herman, V. L., & Lieven, A. (2006) · Value in Health · doi:10.1111/j.1524-4733.2006.00129.x · Cited by 35
A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study)
on behalf of the OPTI-SCRIPT study team, Clyne, B., Cooper, J. A., Hughes, C. M., Fahey, T. P., & Smith, S. M. (2016) · Trials · doi:10.1186/s13063-016-1513-z · Cited by 32
“The fact that only a small proportion of the control group implemented changes reinforces the evidence that less intensive feedback on prescribing behaviour is generally not sufficient to impact on prescribing practices [32, 33].”
Background
Quality of interaction between primary health-care providers and patients with type 2 diabetes in Muscat, Oman: an observational study
Abdulhadi, N. N., Al‐Shafaee, M., Östenson, C., Vernby, Å., & Wahlström, R. (2006) · BMC Family Practice · doi:10.1186/1471-2296-7-72 · Cited by 34
Promoting Physical Health In Youth Mental Health Services: Ensuring Routine Monitoring of Weight and Metabolic Indices in a First Episode Psychosis Clinic
Hetrick, S. E., Álvarez‐Jiménez, M., Parker, A. G., Hughes, F., Willet, M. R., Morley, K. I., Fraser, R., McGorry, P. D., & Thompson, A. D. (2010) · Australasian Psychiatry · doi:10.3109/10398561003731189 · Cited by 35
Improving Population Care with an Integrated Electronic Panel Support Tool
Zhou, Y., Unitan, R., Wang, J. J., Garrido, T., Chin, H. L., Turley, M. C., & Radler, L. (2010) · Population Health Management · doi:10.1089/pop.2010.0001 · Cited by 34
“The third function of information technology, performance feedback, can boost provider performance on evidence-based care recommendations.(17,18) Short-term quality improvement initiatives often effectively combine performance audit, provider feedback, and continuing medical education strategies.”
Background
The effect of continuing professional education on health care outcomes: lessons for dementia care
Rampatige, R., Dunt, D. R., Doyle, C., Day, S., & Dort, P. V. (2009) · International Psychogeriatrics · doi:10.1017/s1041610209008746 · Cited by 34
Designing a large-scale multilevel improvement initiative: The improving performance in practice program *
Margolis, P. A., DeWalt, D. A., Simon, J. E., Horowitz, S. D., Scoville, R. P., Kahn, N. B., PERELMAN, R. H., Bagley, B., & Miles, P. V. (2010) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.20080 · Cited by 34
“10 Key concepts from this approach included (1) identifying desired program characteristics based on research about various program users’ (for example, primary-care physicians, specialty boards, payers) needs, including explicit definition of the characteristics of a high-quality program based on this user needs to c…”
BackgroundMethodInfluential
I've got 99 problems but a phone ain't one: Electronic and mobile health in low and middle income countries
Kumar, P. A., Paton, C., & Kirigia, D. G. (2016) · Archives of Disease in Childhood · doi:10.1136/archdischild-2015-308556 · Cited by 36
The role of evidence and context for implementing a multimodal intervention to increase HIV testing
Bokhour, B. G., Saifu, H. N., Goetz, M. B., Fix, G. M., Burgess, J. D., Fletcher, M. D., Knapp, H., & Asch, S. M. (2015) · Implementation Science · doi:10.1186/s13012-015-0214-4 · Cited by 34
“The intervention involved 1) implementing a clinical reminder to provide decision support for HIV testing (see Figure 1), 2) a multifaceted provider activation program conducted by the PLT at site visits to each medical center using academic detailing [13-15], 3) social marketing techniques including provision of pati…”
Method
Systematic review of interventions to increase the delivery of preventive care by primary care nurses and allied health clinicians
McElwaine, K., Freund, M., Campbell, E. M., Bartlem, K. M., Wye, P. M., & Wiggers, J. (2015) · Implementation Science · doi:10.1186/s13012-016-0409-3 · Cited by 37
Barriers to Non-HDL Cholesterol Goal Attainment by Providers
Virani, S. S., Steinberg, L., Murray, T. O., Negi, S., Nambi, V., Woodard, L., Bozkurt, B., Petersen, L. A., & Ballantyne, C. M. (2011) · The American Journal of Medicine · doi:10.1016/j.amjmed.2011.02.012 · Cited by 33
“59 Provider aware that non-HDL-C is a secondary treatment target (item 2) 31 (50) 25 (12) 0.”
Background
A randomised controlled trial of an online menu planning intervention to improve childcare service adherence to dietary guidelines: a study protocol
Yoong, S. L., Grady, A., Wiggers, J., Flood, V. M., Rissel, C. E., Finch, M., Searles, A., Salajan, D., O’Rourke, R., Daly, J., et al. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017498 · Cited by 33
Medicaid insurance status predicts postoperative mortality after total knee arthroplasty in state inpatient databases
Maman, S. R., Andreae, M. H., Gaber-Baylis, L. K., Turnbull, Z. A., & White, R. S. (2019) · Journal of Comparative Effectiveness Research · doi:10.2217/cer-2019-0027 · Cited by 33
Clinical performance feedback and quality improvement opportunities for perioperative physicians
Urman, R. D., Kaye, A., & Okanlawon, O. (2014) · Advances in Medical Education and Practice · doi:10.2147/amep.s62165 · Cited by 33
Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice
Filippi, A., Paolini, I., Innocenti, F., Mazzaglia, G., Battaggia, A., & Brignoli, O. (2009) · Journal of Human Hypertension · doi:10.1038/jhh.2009.14 · Cited by 33

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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