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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Professional medical education approaches: mobilizing evidence for clinicians
Lyu, X., & Li, S. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1071545 · Cited by 11
“According to a systematic review, audit and feedback could increase clinicians’ compliance with desired practices by ∼7% compared with no intervention (61).”
Background
Automated Data Mining of A Proprietary Database System for Physician Quality Improvement
Johnstone, P. A. S., Crenshaw, T., Cassels, D. G., & Fox, T. H. (2007) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2007.08.056 · Cited by 10
Establishing standards for obstructed labour in a low-income country
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Variation in Surgical Treatment of Abdominal Aortic Aneurysms With Small Aortic Diameters in the Netherlands
Karthaus, E. G., Vahl, A. C., van der Werf, L. R., Elsman, B. H. P., van Herwaarden, J. A., Wouters, M. W. J. M., & Hamming, J. F. (2018) · Annals of Surgery · doi:10.1097/sla.0000000000003050 · Cited by 10
Medication safety in primary care—from measurement to action
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Medical leadership and management: An international revolution
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“[21] Furthermore, this process is typically driven from the top down and so doctors in training gain very little insight into the importance of the subject of the audit area to the wider system or more importantly, do not gain experience in leading the resulting change.”
Background
Are Performance Measures Based on Automated Medical Records Valid for Physician/Practice Profiling of Asthma Care?
Fuhlbrigge, A. L., Carey, V. J., Finkelstein, J. A., Lozano, P., Inui, T. S., & Weiss, K. B. (2008) · Medical Care · doi:10.1097/mlr.0b013e3181618ec9 · Cited by 10
“In addition, Jamtvedt et al has published a systematic review on the available evidence that informs practical decision about how to use audit and feedback to improve quality of care.(18,19) They observed that audit and feedback can improve clinical practice.”
Background
Improving the management of acute coronary syndromes in Australia: translating evidence to outcomes
Huynh, L. T., Phillips, P. A., & Chew, D. P. (2007) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2007.01373.x · Cited by 10
Performance Management Tools Motivate Change at the Frontlines
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Clinically led performance management in secondary healthcare: evaluating the attitudes of medical and non-clinical managers
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The Multisystemic Therapy® Quality Assurance/Quality Improvement System
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Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI
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Improving Hepatitis C Identification: Technology Alone Is Not the Answer
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Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma
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Influence of medical audit on electrodiagnostic evaluation of polyneuropathy. A multicentre study
Pugdahl, K., Tankişi, H., Fuglsang‐Frederiksen, A., Johnsen, B., de Carvalho, M. A., Fawcett, P. R. W., Labarre‐Vila, A., Liguori, R., Nix, W. A., Olsen, M. L., et al. (2004) · Clinical Neurophysiology · doi:10.1016/j.clinph.2004.07.026 · Cited by 10
Selecting the Right Integration of Research Into Practice Strategy
Eastwood, G. M., O'Connell, B. O., & Gardner, A. (2008) · Journal of Nursing Care Quality · doi:10.1097/01.ncq.0000324591.76590.e9 · Cited by 10
The multidisciplinary audit in enhanced recovery after surgery (ERAS) colorectal surgery: experience in a single Italian center
CONTI, D., Pandolfini, L., Ballo, P., ROLLO, S., NA’ARANI, A., VALORIANI, J., Paroli, G. M., Pazzi, M., Laessig, R., Falsetto, A., et al. (2023) · Minerva Surgery · doi:10.23736/s2724-5691.22.09830-6 · Cited by 9
Moving balance and mobility evidence in to action: A primer in knowledge translation
Sibley, K. M., Straus, S. E., Webster, F., & Jaglal, S. B. (2011) · Gait & Posture · doi:10.1016/j.gaitpost.2011.03.002 · Cited by 9
“systems (checking data against clinical rules and providing prompts for action) [39], outreach visits (taking the intervention to the workplace of the end-user) [40], and to a lesser extent, patient-directed interventions and audit and feedback techniques (providing summaries of health care performance over a given ti…”
Background
Regulated provider perceptions of feedback reports
O’Rourke, H. M., Fraser, K. D., Boström, A., Baylon, M. A. B., & Sales, A. E. (2013) · Journal of Nursing Management · doi:10.1111/jonm.12070 · Cited by 9
Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the “Act in Time” Mixed Methods Process Evaluation Study
Strid, E. N., Wallin, L., & Nilsagård, Y. E. (2022) · JMIR Research Protocols · doi:10.2196/37634 · Cited by 10
“• Audit and feedback [56] • Change leadership model [43,44] • Facilitation [38] • Activity log [55] • Facilitation [36-38,53,54] • Activity log [55] Justification”
Background
Effects of the implementation of a breastfeeding best practice guideline in a Canadian public health agency
Rempel, L. A., & McCleary, L. (2012) · Research in Nursing & Health · doi:10.1002/nur.21495 · Cited by 9
Protocol for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study: a cluster randomised controlled trial using ePrescribing data
Guthrie, B., Treweek, S. P., Petrie, D., Barnett, K. N., Ritchie, L. D., Robertson, C., & Bennie, M. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-002359 · Cited by 9
The use of patient experience survey data by out-of-hours primary care services: a qualitative interview study
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Impact of a fall prevention education program for health and exercise professionals: a randomised controlled trial
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Partnerships
Elston, J. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0056 · Cited by 9
A cluster randomized trial assessing the impact of personalized prescribing feedback on antibiotic prescribing for uncomplicated acute cystitis to family physicians
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“Clinical performance feedback has been shown to be an effective low-cost intervention in several settings for changing prescribing behaviour [17, 33, 34].”
Background
Does a diabetes annual review make a difference?
Kenealy, T. W., Orr‐Walker, B., Cutfield, R. G., Robinson, E., Buetow, S., & Simmons, D. S. (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03533.x · Cited by 9
Exportability of an Intervention to Increase HIV Testing in the Veterans Health Administration
Goetz, M. B., Hoang, T., Knapp, H., Henry, S. R., Anaya, H. D., Chou, A. F., Gifford, A. L., & Asch, S. M. (2011) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(11)37071-7 · Cited by 9
Impacts des revues de morbidité-mortalité. Expérience du réseau Aurore de 2005 à 2007
Carrabin, N., Huissoud, C., Dupont, C., Colin, C., & Rudigoz, R.-C. (2009) · Journal de gynécologie, obstétrique et biologie de la reproduction. Supplément/Journal de gynécologie obstétrique et biologie de la reproduction · doi:10.1016/j.jgyn.2009.03.004 · Cited by 9
The Evidence-Based Dentistry Champions: A Grassroots Approach to the Implementation of EBD
Frantsve‐Hawley, J., & Meyer, D. M. (2008) · Journal of Evidence Based Dental Practice · doi:10.1016/j.jebdp.2008.03.001 · Cited by 9
Effecting change in primary care management of respiratory conditions: a global scoping exercise and literature review of educational interventions to inform the IPCRG's E-Quality initiative
McDonnell, J., Williams, S., Chavannes, N. H., de Sousa, C. J., Fardy, H. J., Fletcher, M. J., Stout, J. W., Tomlins, R., Yusuf, O. M., & Pinnock, H. (2012) · Primary Care Respiratory Journal · doi:10.4104/pcrj.2012.00071 · Cited by 9
Electronic Health Record–Based Monitoring of Primary Care Patients at Risk of Medication-Related Toxicity
Bundy, D. G., Marsteller, J. A., Wu, A. W., Engineer, L. D., Berenholtz, S. M., Caughey, A. H., Silver, D. W., Tian, J., Thompson, R. E., Miller, M. R., et al. (2012) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(12)38027-6 · Cited by 9
Investment in quality improvement: how to maximize the return
Gandjour, A. (2009) · Health Economics · doi:10.1002/hec.1449 · Cited by 9
Informational Support in Pediatric Oncology: Review of the Challenges Among Arab Families
Otmani, N., & Khattab, M. (2016) · Journal of Cancer Education · doi:10.1007/s13187-016-1137-8 · Cited by 9
Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway
Bjellmo, S., Hjelle, S., Krebs, L., Magnussen, E. B., & Vik, T. (2019) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-019-2464-7 · Cited by 9
“A perinatal audit, defined as a systematic and critical analysis of the quality of the medical care of pregnant women and their newborns [9, 10] complement the findings provided by large register-based studies by identifying and analysing rare events, as well as provide a basis for proposing suggestions for improvemen…”
Background
Feedback and reminders
van der Weijden, T., Wensing, M., Eccles, M., & Grol, R. P. T. M. (2013) · Wiley eBooks · doi:10.1002/9781118525975.ch13 · Cited by 9
Clinical audit to improve obstetric practice: What is the evidence?
Kongnyuy, E. J. (2009) · Clinical Audit · doi:10.2147/ca.s6442 · Cited by 8
“Introduction The term audit has been defined as “any summary of clinical performance of health care over a specified period of time”.(1) There are three main approaches to obstetric audit namely audit of deaths (maternal or perinatal), audit of severe morbidity (or near-miss), and audit of clinical practice.”
BackgroundResultInfluential
Level of lipopolysaccharide-binding protein and microbial landscape with account of severity of sepsis syndromes in polytrauma
Ustyantseva, I. M., Khokhlova, O., Петухова, О. В., & Жевлакова, Ю. А. (2013) · Critical Care · doi:10.1186/cc12229 · Cited by 8
Adherence to therapeutic hypothermia guidelines for out-of-hospital cardiac arrest
Boyce, R., Bures, K., Czamanski, J., & Mitchell, M. L. (2012) · Australian Critical Care · doi:10.1016/j.aucc.2012.02.006 · Cited by 8
“A Cochrane review of the effect of audit and feedback on professional practice and health care outcomes examined 118 studies and concluded there was a greater effect when there is low baseline adherence and a multipronged approach to the delivery of feedback 18 .”
The role of information technology in translating educational interventions into practice: an analysis using the PRECEDE/PROCEED model
Weir, C. R., McLeskey, N., Brunker, C. P., Brooks, D., & Supiano, M. A. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2010-000076 · Cited by 8
The Effects of Resident Peer- and Self-Chart Review on Outpatient Laboratory Result Follow-up
Hale, A. J., Nall, R. W., Mukamal, K. J., Libman, H., Smith, C., Sternberg, S. B., Kim, H. S., & Kriegel, G. (2015) · Academic Medicine · doi:10.1097/acm.0000000000000992 · Cited by 8
Standardizing Nurse Leader Safety Rounds to Promote Highly Reliable Care
Meyer, P., Hill, C., & Baker, D. C. (2019) · Journal of Nursing Care Quality · doi:10.1097/ncq.0000000000000445 · Cited by 9
Effectiveness of a program to improve antibiotic use in children hospitalized in a children’s tertiary care facility in Argentina
(2014) · Archivos Argentinos de Pediatria · doi:10.5546/aap.2014.eng.124 · Cited by 8
The Effect of Printed Educational Material from the Coroner in Victoria, Australia, on Changing Aged Care Health Professional Practice: A Subscriber Survey
Ibrahim, J., Ehsani, J. P., & McInnes, J. A. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02742.x · Cited by 8
“This is a surprising result in light of the previously reported small effects of education through printed education material(17) and the moderate effects of audit and feedback on change to practice.(23) Another survey-based study investigating the effect of a different newsletter from the Victorian state Coroner’s Of…”
Result
Influence of an e-mail with a drug information attachment on sales of prescribed drugs: a randomized controlled study
Edward, C., Himmelmänn, A., & Wallerstedt, S. M. (2007) · BMC Clinical Pharmacology · doi:10.1186/1472-6904-7-12 · Cited by 8
External feedback in general practice: a focus group study of trained peer reviewers of significant event analyses
McKay, J., Pope, L. M., Bowie, P., & Lough, M. (2009) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2008.00969.x · Cited by 8
No Clinic Left Behind: Providing Cost-Effective In-Services Via Distance Learning
Knapp, H., Fletcher, M., Taylor, A., Chan, K., & Goetz, M. B. (2011) · Journal for Healthcare Quality · doi:10.1111/j.1945-1474.2011.00117.x · Cited by 8

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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