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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Background
Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial
Fiks, A. G., Mayne, S. L., Michel, J. J., Miller, J. M., Abraham, M., Suh, A. W., Jawad, A. F., Guevara, J. P., Grundmeier, R. W., Blum, N. J., et al. (2017) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000490 · Cited by 26
CLINICAL AUDITS: WHY AND FOR WHOM
Boult, M., & Maddern, G. J. (2007) · ANZ Journal of Surgery · doi:10.1111/j.1445-2197.2007.04140.x · Cited by 26
Doctors and quality improvement
Hockey, P., & Marshall, M. (2009) · Journal of the Royal Society of Medicine · doi:10.1258/jrsm.2009.090065 · Cited by 27
Understanding feedback report uptake: process evaluation findings from a 13-month feedback intervention in long-term care settings
Sales, A. E., Fraser, K. D., Baylon, M. A. B., O’Rourke, H. M., Gao, G., Bucknall, T. K., & Maisey, S. (2015) · Implementation Science · doi:10.1186/s13012-015-0208-2 · Cited by 25
“This raises the question of why the feedback intervention was less successful than we had expected as we initiated the study, based on the most current reviews of feedback interventions [21,22].”
BackgroundMethod
Management of Hospital Infection Control in Iran: A Need for Implementation of Multidisciplinary Approach
Mamishi, S., Pourakbari, B., Teymuri, M., Babamahmoodi, A., & Mahmoudi, S. (2014) · Osong Public Health and Research Perspectives · doi:10.1016/j.phrp.2014.06.001 · Cited by 25
“According to the Cochrane systematic review of 118 trials to evaluate the effects of audit and feedback on the practices of HCWs, such as antibiotic prescribing, hand washing, and glove use, an improvement in patient outcomes was seen [28].”
Background
Effect of benchmarking projects on outcomes of coronary artery bypass graft surgery: Challenges and prospects regarding the quality improvement initiative
Miyata, H., Motomura, N., Murakami, A., & Takamoto, S. (2012) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2011.07.010 · Cited by 25
Antipsychotic Cardiometabolic Side Effect Monitoring in a State Community Mental Health System
Cotes, R. O., de Nesnera, A., Kelly, M., Orsini, K., Xie, H., McHugo, G. J., Bartels, S. J., & Brunette, M. F. (2015) · Community Mental Health Journal · doi:10.1007/s10597-015-9833-0 · Cited by 27
An interdisciplinary knowledge translation intervention in long-term care: Study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial
Kennedy, C. C., Ioannidis, G., Giangregorio, L., Adachi, J. D., Thabane, L., Morin, S. N., Crilly, R. G., Marr, S., Josse, R. G., Lohfeld, L. H., et al. (2012) · Implementation Science · doi:10.1186/1748-5908-7-48 · Cited by 25
Public stewardship of private for-profit healthcare providers in low- and middle-income countries
Wiysonge, C. S., Abdullahi, L. H., Ndze, V. N., & Hussey, G. D. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009855.pub2 · Cited by 25
‘Evidence‐based implementation’ of paediatric asthma guidelines in a rural emergency department
Doherty, S., Jones, P. D., Stevens, H. E., Davis, L., Ryan, N. J., & Treeve, V. (2007) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.2007.01151.x · Cited by 25
Poor quality of antenatal care services—Is lack of competence and support the reason? An observational and interview study in rural areas of Lao PDR
Manithip, C., Edin, K. E., Sihavong, A., Wahlström, R., & Wessel, H. (2012) · Midwifery · doi:10.1016/j.midw.2011.12.010 · Cited by 24
Exploring Systems That Support Good Clinical Care in Indigenous Primary Health-care Services: A Retrospective Analysis of Longitudinal Systems Assessment Tool Data from High-Improving Services
Woods, C., Carlisle, K., Larkins, S., Thompson, S., Tsey, K., Matthews, V., & Bailie, R. S. (2017) · Frontiers in Public Health · doi:10.3389/fpubh.2017.00045 · Cited by 24
Early oral feeding after colorectal surgery: A mixed methods study of knowledge translation
Robertson, T., Eldridge, N. E., Rattray, M., Roberts, S., Desbrow, B., Marshall, A. P., Ali, A., & Hickman, I. J. (2018) · Nutrition & Dietetics · doi:10.1111/1747-0080.12473 · Cited by 24
Pharmacy Students’ Views of Faculty Feedback on Academic Performance
Hall, M., Hanna, L., & Quinn, S. (2012) · American Journal of Pharmaceutical Education · doi:10.5688/ajpe7615 · Cited by 25
“The authors cautioned that the effects are generally small to moderate and effectiveness is likely to be greater when baseline adherence to recommended practice is low and when feedback is delivered more intensively.(8) With specific reference to pharmacy, Watson and colleagues conducted a randomized controlled trial…”
Background
Educating staff working in long-term care about delirium: The Trojan horse for improving quality of care?
Siddiqi, N., Young, J. B., Cheater, F., & Harding, R. A.-M. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2008.05.014 · Cited by 24
Self-citation
Reducing Skin Breakdown in Patients Receiving Extracorporeal Membranous Oxygenation
Clements, L., MOORE, M. J., Tribble, T., & Blake, J. (2014) · Nursing Clinics of North America · doi:10.1016/j.cnur.2013.11.003 · Cited by 24
A Consecutive and Prospective Stroke Database Covers the State of Baden-Wuerttemberg with 10.8 Million Inhabitants in Germany
Gumbinger, C., Reuter, B., Wiethölter, H., Bruder, I., Rode, S., Drewitz, E., Habscheid, W., Daffertshofer, M., Diehm, C., Neumaier, S., et al. (2013) · Neuroepidemiology · doi:10.1159/000354356 · Cited by 24
Improving the implementation of perioperative safety guidelines using a multifaceted intervention approach: protocol of the IMPROVE study, a stepped wedge cluster randomized trial
Emond, Y., Calsbeek, H., Teerenstra, S., Bloo, G., Westert, G. P., Damen, J., Wolff, A. P., & Wollersheim, H. C. H. (2015) · Implementation Science · doi:10.1186/s13012-014-0198-5 · Cited by 24
Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial
Bilardi, J., Fairley, C. K., Temple-Smith, M. J., Pirotta, M. V., McNamee, K. M., Bourke, S., Gurrin, L. C., Hellard, M. E., Sanci, L. A., Wills, M. J., et al. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-70 · Cited by 24
Informal social accountability in maternal health service delivery: A study in Northern Malawi
Lodenstein, E., Ingemann, C., Molenaar, J. M., Dieleman, M. A., & Broerse, J. E. W. (2018) · PLoS ONE · doi:10.1371/journal.pone.0195671 · Cited by 24
“…of “feedback” to refer to the actual interaction process between social actors and HWs. Adapted from a definition of feedback in clinical settings by Jamtvedt et al. (2010), feedback is defined as a statement or a summary of performance of delivery care over a specified period of time or…”
Background
Practice development plans to improve the primary care management of acute asthma: randomised controlled trial
Foster, J. M., Hoskins, G., Smith, B., Lee, A. J., Price, D. B., & Pinnock, H. (2007) · BMC Family Practice · doi:10.1186/1471-2296-8-23 · Cited by 24
“There is no consensus on the ideal duration of educational intervention studies,[18] though six months is the median duration of trials reviewed by Wensing,[32] Ideal duration is a balance between the time needed to effect change, whilst avoiding the danger of deterioration if the time scale were too prolonged[18].”
How do we improve quality in primary dental care?
Campbell, S., & Tickle, M. (2013) · BDJ · doi:10.1038/sj.bdj.2013.831 · Cited by 23
Measuring performance in skin cancer practice: the SCARD initiative
Rosendahl, C. O., Hansen, C. A., Cameron, A., Bourne, P., Wilson, T., Cook, B., Baker, M., Keir, J., Dicker, T., Reid, M., et al. (2010) · International Journal of Dermatology · doi:10.1111/j.1365-4632.2010.04608.x · Cited by 23
Appraising Evidence for Intervention Effectiveness in Early Psychosis: Conceptual Framework and Review of Evaluation Approaches
Catts, S. V., O’Toole, B. I., Carr, V. J., Lewin, T. J., Neil, A. L., Harris, M., Frost, A. D. J., Crissman, B., Eadie, K., & Evans, R. W. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048670903487167 · Cited by 23
Improving patient-centeredness of fertility care using a multifaceted approach: study protocol for a randomized controlled trial
Huppelschoten, A. G., van Duijnhoven, N. T. L., Hermens, R., Verhaak, C. M., Kremer, J. A. M., & Nelen, W. L. D. M. (2012) · Trials · doi:10.1186/1745-6215-13-175 · Cited by 25
“However, it is shown that audit and feedback alone is not enough; the effectiveness increases if feedback is detailed, offered in high intensity, with professionals’ involvement and as part of a multifaceted intervention [39-42].”
BackgroundMethodResult
Systems changes to prevent severe hyperbilirubinemia and promote breastfeeding: pilot approaches
Stark, A. R., & Lannon, C. (2009) · Journal of Perinatology · doi:10.1038/jp.2008.215 · Cited by 23
Heavy Tailed Distributions of Effect Sizes in Systematic Reviews of Complex Interventions
Burton, C. D. (2012) · PLoS ONE · doi:10.1371/journal.pone.0034222 · Cited by 23
“Audit & Feedback [21] Audit & Feedback alone C 13 1.”
BackgroundMethod
Confidential enquiries into hypoxic ischaemic encephalopathy
Buchmann, E., & Velaphi, S. (2009) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2008.12.004 · Cited by 23
Barriers and facilitators of thromboprophylaxis for medical-surgical intensive care unit patients: A multicenter survey
Cook, D., Duffett, M., Lauzier, F., Ye, C., Dodek, P., Paunovic, B. N., Fowler, R. A., Kho, M. E., Foster, D., Stelfox, H. T., et al. (2014) · Journal of Critical Care · doi:10.1016/j.jcrc.2014.01.017 · Cited by 22
Use of Evidence‐Based Practice in School Nursing: Prevalence, Associated Variables, and Perceived Needs
Adams, S. L., & Barron, S. (2008) · Worldviews on Evidence-Based Nursing · doi:10.1111/j.1741-6787.2008.00141.x · Cited by 23
Teamwork among midwives during neonatal resuscitation at a maternity hospital in Nepal
Wrammert, J., Sapkota, S., Baral, K. P., Ashish, K. C., Målqvist, M., & Larsson, M. (2017) · Women and Birth · doi:10.1016/j.wombi.2017.02.002 · Cited by 23
Best Ways to Provide Feedback to Radiologists on Mammography Performance
Bowles, E. J. A., & Geller, B. M. (2009) · American Journal of Roentgenology · doi:10.2214/ajr.08.2051 · Cited by 23
“Several reviews have shown that they result in small to moderate effects on performance in clinical practice and are more effective when baseline performance is at a low level, when combined with educational meetings, or when administered by an authoritative figure [12,13,20].”
Background
Counselor Incentives to Improve Client Retention in an Outpatient Substance Abuse Aftercare Program
Shepard, D. S., Calabro, J. A. B., Love, C. T., McKay, J. R., Tetreault, J., & Yeom, H. S. (2006) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-006-0054-2 · Cited by 23
Implementing a Tobacco Assisted Referral Program in Dental Practices
Little, S. J., Hollis, J. F., Fellows, J. L., Snyder, J. J., & Dickerson, J. F. (2009) · Journal of Public Health Dentistry · doi:10.1111/j.1752-7325.2008.00113.x · Cited by 22
Geographic Concentration of Poverty and Arteriovenous Fistula Use among ESRD Patients
McClellan, W. M., Wasse, H., McClellan, A. C., Holt, J. B., Krisher, J., & Waller, L. A. (2010) · Journal of the American Society of Nephrology · doi:10.1681/asn.2009121235 · Cited by 22
Repeat Auditing of Primary Health-care Facilities Against Standards for Occupational Health and Infection Control: A Study of Compliance and Reliability
Cloete, B., Yassi, A., & Ehrlich, R. I. (2019) · Safety and Health at Work · doi:10.1016/j.shaw.2019.12.001 · Cited by 22
“The relative effects of clinical audit and feedback are thus likely to be larger when baseline compliance with standards is low [ [31].”
Background
Expanding nurse initiated X-rays in emergency care using team-based learning and decision support
Considine, J., Payne, R., Williamson, S., & Currey, J. (2013) · Australasian Emergency Nursing Journal · doi:10.1016/j.aenj.2012.11.001 · Cited by 22
Managing hospital doctors and their practice: what can we learn about human resource management from non-healthcare organisations?
Trebble, T. M., Heyworth, N., Clarke, N. M. P., Powell, T., & Hockey, P. (2014) · BMC Health Services Research · doi:10.1186/s12913-014-0566-5 · Cited by 22
“There is a paucity of published examples of successful models for managing individual clinicians in secondary care with only limited sustained benefit demonstrated from clinical audit, feedback and education [36,37] and conflicting results of productivity based interventions in clinical practice [38,39].”
Background
Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis
Hoffman, S. J., Guindon, G. E., Lavis, J. N., Randhawa, H., Becerra-Posada, F., Dejman, M., Falahat, K., Malekafzali, H., Ramachandran, P., Shi, G., et al. (2016) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.15-0538 · Cited by 24
Giving and promising gifts: Experimental evidence on reciprocity from the field
Brock, J., Lange, A., & Leonard, K. L. (2018) · Journal of Health Economics · doi:10.1016/j.jhealeco.2018.02.007 · Cited by 21
Doctors on the move: a European case study on the key characteristics of national recertification systems
Sehlbach, C., Govaerts, M., Mitchell, S., Rohde, G. G. U., Smeenk, F. W. J. M., & Driessen, E. W. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019963 · Cited by 24
Feedback to professionals on patient-centered fertility care is insufficient for improvement: a mixed-method study
Huppelschoten, A. G., Aarts, J. W. M., van Empel, I. W. H., Cohlen, B. J., Kremer, J. A. M., & Nelen, W. L. D. M. (2013) · Fertility and Sterility · doi:10.1016/j.fertnstert.2012.12.024 · Cited by 22
Peri-operative nurses’ knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study
Sutherland‐Fraser, S., McInnes, E., Maher, E. J., & Middleton, S. (2012) · BMC Nursing · doi:10.1186/1472-6955-11-25 · Cited by 22
“Educational strategies that are combined with either audit and feedback [31,59]; the introduction of recommended pressure relieving devices [18]; and simultaneous introduction of”
Background
Risk-adjusted surveillance of hospital-acquired infections in neonatal intensive care units: a systematic review
Phillips, P. P. J., Cortina‐Borja, M., Millar, M. R., & Gilbert, R. E. (2008) · Journal of Hospital Infection · doi:10.1016/j.jhin.2008.06.014 · Cited by 22
Implementation of an audit with feedback knowledge translation intervention to promote medication error reporting in health care: a protocol
Hutchinson, A. M., Sales, A. E., Brotto, V., & Bucknall, T. K. (2015) · Implementation Science · doi:10.1186/s13012-015-0260-y · Cited by 22
“Additionally, the literature provides limited description of feedback innovations in terms of the process of development and design characteristics [11, 12, 15].”
BackgroundResultInfluential
High-risk prescribing and monitoring in primary care: how common is it, and how can it be improved?
Dreischulte, T., & Guthrie, B. (2012) · Therapeutic Advances in Drug Safety · doi:10.1177/2042098612444867 · Cited by 22
Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727]
MacDermid, J. C., Solomon, P. E., Law, M., Russell, D. J., & Stratford, P. W. (2006) · Implementation Science · doi:10.1186/1748-5908-1-14 · Cited by 22
Translating knowledge to practice: optimizing the use of guidelines
Gagliardi, A. R. (2012) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796012000212 · Cited by 22
“These strategies can have a small to moderate impact either alone or in combination, but not consistently (O’Brien et al. 1997, 2001; Davis et al. 1999; Wolff et al. 2004; Garg et al. 2005; Grimshaw et al. 2006; Jamtvedt et al. 2006; Doumit et al. 2007; Mehrotra et al. 2009).”
Background

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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