Audit and feedback: effects on professional practice and health care outcomes

  • Review
  • Intervention

Authors


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 methods

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.

摘要

背景

稽核與回饋:對於專家做法與健康照護結果的影響

一直以來稽核與回饋被廣泛地作為改善專家做法的策略。這似乎符合邏輯,如果健康照護專家已知回饋關於他們的臨床做法與同儕或公認的指引是不一致的,將促使健康照護專家修改他們的做法。然而,始終沒有發現稽核與回饋具有效果。

目標

評估稽核與回饋對於健康照護專家做法及病患結果的影響。

搜尋策略

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。

選擇標準

稽核與回饋(定義為在一段特定期間內任何臨床行為的總評)的隨機試驗,報告客觀測量健康照護機構中專家的做法或健康照護的結果。

資料收集與分析

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(metaregression)),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。

主要結論

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,interquartile range = 0.03至0.11),且調整後RR為0.71至18.3(median = 1.08,interquartile 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,interquartile 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)。

作者結論

稽核與回饋可以有效改善專家做法。當它是有效的時候,這種效果通常是小至中度。當建議做法的基礎遵從性不高且當密集地提供回饋時,稽核與回饋的相對效果有可能較大。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

提供健康照護專家有關他們表現的資料(稽核與回饋)也許有助於改善他們的做法。稽核與回饋可以改善專家的做法,但效果不同。當它是有效的時候,效果通常是小至中度。這篇回顧的結果不支持強制或未評估的使用稽核與回饋作為改變做法的介入措施。

Plain language summary

Audit and feedback: effects on professional practice and health care outcomes

Providing healthcare professionals with data about their performance (audit and feedback) may help improve their practice.
Audit and feedback can improve professional practice, but the effects are variable. When it is effective, the effects are generally small to moderate. The results of this review do not support mandatory or unevaluated use of audit and feedback as an intervention to change practice.

Ancillary