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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Hulse, N. C., Fiol, G. D., Bradshaw, R. L., Roemer, L. K., & Rocha, R. A. (2007) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2007.05.006 · Cited by 17
Efectividad de una intervención de mejora de calidad en la reducción del riesgo cardiovascular en pacientes hipertensos
García‐Ortiz, L., Rodríguez, I. S., Fernández, P. L. S., Santiago, M. C. M., Maya, J. A., & Corral, M. T. R. (2004) · Revista Española de Cardiología · doi:10.1016/s0300-8932(04)77165-1 · Cited by 17
Variations in Chronic Obstructive Pulmonary Disease Outpatient Care in Respiratory Clinics: Results From the 2021 EPOCONSUL Audit
Rubio, M. C., López-Campos, J. L., Miravitlles, M., Soler‐Cataluña, J. J., Navarrete, B. A., Fuentes, M. E., & Hermosa, J. L. R. (2023) · Archivos de Bronconeumología · doi:10.1016/j.arbres.2023.02.004 · Cited by 16
The feasibility of automating audit and feedback for ART guideline adherence in Malawi
Lewis, Z. L., Mello-Thoms, C. R., Gadabu, O. J., Gillespie, E. M., Douglas, G. P., & Crowley, R. S. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000097 · Cited by 16
“We calculated frequency of encounters at a monthly interval based on Jamtvedt et al’s designation of a monthly interval as a moderate frequency.(16) We analyzed the frequency of recommendations to identify recommendations for which we could more adequately assess HCW adherence, as more frequently occurring recommendat…”
BackgroundMethodInfluential
Effect of an educational intervention in primary care physicians on the compliance of indicators of good clinical practice in the treatment of type 2 diabetes mellitus [OBTEDIGA project]
Vidal-Pardo, J. I., Pérez-Castro, T. R., López-Álvarez, X. L., Santiago-Pérez, M. I., Soidán, F. J. G., & Muñiz, J. (2013) · International Journal of Clinical Practice · doi:10.1111/ijcp.12145 · Cited by 16
Development of quality indicators based on a multidisciplinary, evidence-based guideline on pediatric constipation
Stienen, J. J. C., Tabbers, M. M., Benninga, M. A., Harmsen, M., & Ouwens, M. M. M. T. J. (2011) · European Journal of Pediatrics · doi:10.1007/s00431-011-1458-x · Cited by 16
“effective in changing health care practice [10, 17, 25].”
Prolonged delay for controlling KPC-2–producing Klebsiella pneumoniae outbreak: The role of clinical management
Delory, T., Seringe, E., Antoniotti, G., Novakova, I., Goulenok, C., Paysant, I., Boyer, S., Carbonne, A., Naas, T., & Astagneau, P. (2015) · American Journal of Infection Control · doi:10.1016/j.ajic.2015.05.021 · Cited by 16
The effectiveness of a skin care program for the prevention of contact dermatitis in health care workers (the Healthy Hands Project): study protocol for a cluster randomized controlled trial
Soltanipoor, M., Kežić, S., Sluiter, J. K., & Rustemeyer, T. (2017) · Trials · doi:10.1186/s13063-017-1803-0 · Cited by 16
Designing Strategies to Implement Research-Based Policies and Procedures
Squires, J. E., Reay, T., Moralejo, D. G., LeFort, S. M., Hutchinson, A. M., & Estabrooks, C. A. (2012) · JONA The Journal of Nursing Administration · doi:10.1097/nna.0b013e318253565f · Cited by 16
Suboptimal quality of type 2 diabetes care discovered through electronic feedback led to increased nurse–GP cooperation. A qualitative study
Guldberg, T. L., Vedsted, P., Lauritzen, T., & Zoffmann, V. (2010) · Primary care diabetes · doi:10.1016/j.pcd.2010.01.001 · Cited by 16
Continuing Medical Education Improves Gastroenterologists’ Compliance with Inflammatory Bowel Disease Quality Measures
Sapir, T., Moreo, K., Carter, J. D., Greene, L., Patel, B., & Higgins, P. (2016) · Digestive Diseases and Sciences · doi:10.1007/s10620-016-4061-1 · Cited by 16
Impact of an Extended Audit on Identifying Heart Failure Patients in General Practice: Baseline Results of the OSCAR-HF Pilot Study
Smeets, M., Vaes, B., Aertgeerts, B., de Raat, W. K., Penders, J., Vercammen, J., Droogné, W., Müllens, W., & Janssens, S. P. (2020) · ESC Heart Failure · doi:10.1002/ehf2.12990 · Cited by 16
Comparison of the Impact of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management Trial on Prescribing Patterns: A Time-Series Analysis
Choudhry, N. K., Zagorski, B., Avorn, J., Levin, R., Sykora, K., Laupacis, A., & Mamdani, M. (2008) · Annals of Pharmacotherapy · doi:10.1345/aph.1l211 · Cited by 16
Variation in Clinical Practice: A Priority Setting Approach to the Staged Funding of Quality Improvement
Karnon, J., Partington, A., Horsfall, M., & Chew, D. (2016) · Applied Health Economics and Health Policy · doi:10.1007/s40258-015-0160-y · Cited by 15
Auditing chronic disease care: Does it make a difference?
Essel, V., Vuuren, U. V., Sa, A. D., Govender, S., Murie, K., Schlemmer, A. C., Gunst, C., Namane, M., Boulle, A., & Vries, E. D. (2015) · African Journal of Primary Health Care & Family Medicine · doi:10.4102/phcfm.v7i1.753 · Cited by 15
Tuberculosis screening in patients with HIV: use of audit and feedback to improve quality of care in Ghana
Bjerrum, S., Bonsu, F. A., Hanson-Nortey, N. N., Kenu, E., Johansen, I. S., Andersen, Å. B., Bjerrum, L., Jarbøl, D. E., & Munck, A. (2016) · Global Health Action · doi:10.3402/gha.v9.32390 · Cited by 15
“It is possible that audit and feedback, as part of a multi-faceted intervention with targeted initiatives, could improve performance further (16).”
BackgroundMethod
Steady improvement of infection control services in six community hospitals in Makkah following annual audits during Hajj for four consecutive years
Madani, T. A., Albarrak, A. M., Alhazmi, M. A., Al-Azraqi, T. A., Althaqafi, A. O., & Ishaq, A. H. (2006) · BMC Infectious Diseases · doi:10.1186/1471-2334-6-135 · Cited by 15
Résistance bactérienne et prescription antibiotique : perceptions, attitudes et connaissances d’un échantillon de médecins généralistes
Pulcini, C., Naqvi, A., Gardella, F., Dellamonica, P., & Sotto, A. (2010) · Médecine et Maladies Infectieuses · doi:10.1016/j.medmal.2010.09.018 · Cited by 15
Equity-oriented toolkit for health technology assessment and knowledge translation: application to scaling up of training and education for health workers
Ueffing, E., Tugwell, P., Roberts, J. H., Walker, P., Hamel, N., & Welch, V. A. (2009) · Human Resources for Health · doi:10.1186/1478-4491-7-67 · Cited by 14
Our approach to changing the culture of caring for the acutely unwell patient at a large UK teaching hospital: A service improvement focus on Early Warning Scoring tools
Wood, S., Candeland, J. L., Dinning, A., Dow, S. A., Hunkin, H., McHale, S., McNeill, G., & Taylor, N. (2015) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2014.11.006 · Cited by 15
Managing peripheral venous catheters: an investigation on the efficacy of a strategy for the implementation of evidence‐based guidelines
Frigerio, S., Giulio, P. D., Gregori, D., Gavetti, D., Ballali, S., Bagnato, S., Guidi, G., Foltran, F., & Renga, G. (2010) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2010.01590.x · Cited by 15
Non–high-density lipoprotein cholesterol calculation and goal awareness among physicians-in-training
Negi, S., Steinberg, L., Polsani, V. R., Gowani, S. A., Nambi, V., Kumar, V., Marinescu, V., Jones, P. H., Petersen, L. A., Ballantyne, C. M., et al. (2011) · Journal of clinical lipidology · doi:10.1016/j.jacl.2011.10.020 · Cited by 15
A study of adherence to drug recommendations by providing feedback of outpatient prescribing patterns to hospital specialists
Wettermark, B., Haglund, K., Gustafsson, L. L., Persson, P. M., & Bergman, U. (2005) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.1098 · Cited by 15
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
Reducing Inappropriate Hospital Use on a General Pediatric Inpatient Unit
Mahant, S., Peterson, R., Campbell, M., MacGregor, D., & Friedman, J. (2008) · PEDIATRICS · doi:10.1542/peds.2007-2898 · Cited by 15
Data for improvement and clinical excellence: report of an interrupted time series trial of feedback in long-term care
Sales, A. E., Schalm, C., Baylon, M. A. B., & Fraser, K. D. (2014) · Implementation Science · doi:10.1186/s13012-014-0161-5 · Cited by 15
Increasing identification of foot at risk of complications in patients with diabetes: a quality improvement project in an urban primary health centre in India
Mehndiratta, A., Mishra, S., Bhandarkar, P., Chhatbar, K. C., Cluzeau, F., & Team PrimaryCareDoctors (2020) · BMJ Open Quality · doi:10.1136/bmjoq-2019-000893 · Cited by 14
“27 Such preventive strategies are usually successful with organisational support and a computerised tracking system is used for audit feedback.”
Background
Formative Assessment Based on an Audit and Feedback Improves Nuchal Translucency Ultrasound Image Quality
Chalouhi, G. E., Salomon, L. J., Fontanges, M., Althuser, M., Haddad, G., Scemama, O., Chabot, J.-M., Duyme, M., & Fries, N. (2013) · Journal of Ultrasound in Medicine · doi:10.7863/ultra.32.9.1601 · Cited by 14
Nationwide Environmental Scan of Knowledge Brokers Training
Gaid, D., Mate, K., Ahmed, S., Thomas, A., & Bussières, A. (2021) · Journal of Continuing Education in the Health Professions · doi:10.1097/ceh.0000000000000355 · Cited by 14
Implementation Science to Improve Quality of Neurological Care
Samanta, D., & Landes, S. J. (2021) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2021.05.009 · Cited by 16
Prevention of device‐related infections in patients with cancer: Current practice and future horizons
Viola, G. M., Szvalb, A. D., Malek, A. E., Chaftari, A., Hachem, R. Y., & RAAD, I. I. (2022) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21756 · Cited by 14
“…care unit, and surgical wards 17 ; (3) measuring and providing feedback to providers regarding rates of compliance with process measures 19,28 ; and (4) using an Environmental Protection Agency-approved hospital disinfectant to clean contaminated surfaces, 19 following the American…”
Background
The use of indicators to improve the quality of intensive care
van der Voort, P. H. J., van der Veer, S. N., & de Vos, M. L. G. (2012) · Acta Anaesthesiologica Scandinavica · doi:10.1111/j.1399-6576.2012.02687.x · Cited by 14
“Overall, all reviews on quality improvement strategies concluded that a multifaceted approach seems to be more effective than feedback alone.(16,18,19) Obviously, providing a feedback report has to be followed by subsequent steps such as thorough interpretation of the feedback report and an implementation plan.”
Background
Actitudes de médicos y enfermeras ante las actividades preventivas y de promoción en atención primaria
Ramos‐Morcillo, A. J., Ruzafa‐Martínez, M., Fernández‐Salazar, S., Casado, R. D. P., & Armero‐Barranco, D. (2014) · Atención Primaria · doi:10.1016/j.aprim.2014.02.002 · Cited by 14
“…sería inte-resante 27 28 29 24 reali-zar este tipo de actividades Por último, sería interesante realizar formación, reuniones educativas 27 , auditorías y retroalimentación 26 para que los profesionales tengan el conocimiento acerca del qué, cuándo y dónde deben realizar este tipo de intervenciones”
Invasive Mediastinal Staging Guideline Concordance
Bendzsak, A. M., Waddell, T. K., Yasufuku, K., Keshavjee, S. H., de Perrot, M. E., Cypel, M., Pierre, A. F., & Darling, G. E. (2017) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2016.12.010 · Cited by 14
The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England
Killaspy, H. T., King, M., Holloway, F. A., Craig, T., Cook, S., Mundy, T., Leavey, G., McCrone, P., Koeser, L., Omar, R., et al. (2017) · Programme Grants for Applied Research · doi:10.3310/pgfar05070 · Cited by 17
“Twelve-month outcome Baseline, mean (SD) 12-month follow-up, n (%) Discharged from the rehabilitation unit 219 (66) Ready to be discharged from the rehabilitation unit 48 (14) Discharged or ready to be discharged from the rehabilitation unit 267 (80) Successfully discharged from the rehabilitation unit 187 (56) Succes…”
Method
Electronic Audit and Feedback With Positive Rewards Improve Anesthesia Provider Compliance With a Barcode-Based Drug Safety System
Bowdle, A. T., Jelačić, S., Nair, B. G., Zucker, F. H., Bussey, L., Togashi, K., Yang, J.-T., & Lang, J. D. (2018) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000003861 · Cited by 16
Evaluation of a continuous monitoring and feedback initiative to improve quality of anaesthetic care: a mixed-methods quasi-experimental study
Benn, J. J., Arnold, G., D’Lima, D., Wei, I., Moore, J., Aleva, F. E., Smith, A. F., Bottle, A., & Brett, S. J. (2015) · Health Services and Delivery Research · doi:10.3310/hsdr03320 · Cited by 14
“Higher overall intensity of feedback has been shown to increase its effectiveness.(107,144) A particularly relevant finding concerns the level of feedback provided within a health service.”
BackgroundInfluential
Curricula for teaching the content of clinical practice guidelines to family medicine and internal medicine residents in the US: a survey study
Akl, E. A., Mustafa, R. A., Wilson, M. C., Symons, A. B., Moheet, A. A., Rosenthal, T. C., Guyatt, G. H., & Schünemann, H. J. (2009) · Implementation Science · doi:10.1186/1748-5908-4-59 · Cited by 14
Improving critical care discharge summaries: a collaborative quality improvement project using PDSA
Goulding, L., Parke, H. L., Maharaj, R., Loveridge, R., McLoone, A., Hadfield, S., Helme, E., Hopkins, P. A., & Sandall, J. (2015) · BMJ Quality Improvement Reports · doi:10.1136/bmjquality.u203938.w3268 · Cited by 14
“Two [18,19] out of four [18-21] high quality literature reviews conclude that audit and feedback is an effective behaviour change tool.”
Effectiveness and costs of implementation strategies to reduce acid suppressive drug prescriptions: a systematic review
Smeets, H. M., Hoes, A. W., & de Wit, N. J. (2007) · BMC Health Services Research · doi:10.1186/1472-6963-7-177 · Cited by 13
Data for Improvement and Clinical Excellence: a report of an interrupted time series trial of feedback in home care
Fraser, K. D., Sales, A. E., Baylon, M. A. B., Schalm, C., & Miklavcic, J. J. (2017) · Implementation Science · doi:10.1186/s13012-017-0600-1 · Cited by 14
“Case managers have complex caseloads that vary depending on the type of client, for example, whether they are short-term post hospital care, pediatric, or long-term maintenance clients [7].”
Background
Caries treatment in a dental practice‐based research network: movement toward stated evidence‐based treatment
Gilbert, G. H., Gordan, V. V., Funkhouser, E. M., Rindal, D. B., Fellows, J. L., Qvist, V., Anderson, G., Worley, D., & The National Dental PBRN Collaborative Group (2013) · Community Dentistry and Oral Epidemiology · doi:10.1111/cdoe.12008 · Cited by 12
The UK National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project – a feasibility study of large‐scale clinical service peer review
Roberts, C. M., Buckingham, R. J., Stone, R. A., Lowe, D., & Pearson, M. G. (2010) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2009.01224.x · Cited by 13
Effect of health professional education on outcomes of chronic obstructive pulmonary disease in primary care: A non randomized clinical trial
Monteagudo, M., Rodríguez-Blanco, T., Llagostera, M., Valero, C., Huguet, X. B., Granollers, S., Ferro, J. J., Acedo, M., Almeda, J., Rodríguez-Latre, L., et al. (2013) · Respirology · doi:10.1111/resp.12074 · Cited by 13
The challenge of transferring an implementation strategy from academia to the field
Trietsch, J., van Steenkiste, B., Hobma, S., Frericks, A., Grol, R. P. T. M., Metsemakers, J. F. M., & van der Weijden, T. (2014) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12287 · Cited by 13
Improved guideline compliance after a 3‐year audit of multidisciplinary colorectal cancer care in the western part of the Netherlands
van der Geest, L. G., Krijnen, P., Wouters, M. W. J. M., Erkelens, W. G., Marinelli, A. W. K. S., Nortier, H. W. R., Tollenaar, R. A. �. �., & Struikmans, H. (2012) · Journal of Surgical Oncology · doi:10.1002/jso.23038 · Cited by 13
“Therefore, the Cochrane EPOC group stresses the need of well-designed trials to evaluate the effectiveness of different audit and feedback strategies [14].”
BackgroundResult

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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