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.
To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes.
We searched the Cochrane Effective Practice and Organisation of Care Group's register and pending file up to January 2004.
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.
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.
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.
我們檢索the Cochrane Effective Practice and Organisation of Care Group's register並等待文件到2004年1月。
兩名回顧者分別摘錄資料並評估研究的品質。進行量性(統合迴歸(metaregression))，觀察與質性分析。在調整基礎的遵從性後，我們計算每一比較組其二分變項結果的風險差(risk difference (RD))及相對風險(risk ratio (RR))，及連續變項的百分比與相較於對照組之百分比的平均改變量。
這次更新增加了30篇研究，總共納入118篇研究。初步分析納入了72篇研究共88個比較組，比較任何有稽核與回饋作為要素的介入措施對照於無介入措施。有關二分變項結果，遵從性與理想做法的RD從−0.16(遵從組絕對減少16%)至0.70(遵從組增加70%)(median = 0.05，interquartile range = 0.03至0.11)，且調整後RR為0.71至18.3(median = 1.08，interquartile range = 0.99至1.30)。有關連續變項結果，相較於對照組調整後百分比改變量為−0.10(遵從組絕對減少10%)至0.68(遵從組增加68%) (median = 0.16，interquartile range = 0.05至0.37)。建議做法的基礎遵從性低及密集度高的稽核與回饋兩者與較高的調整後風險對比值有關(效果較大)。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。