Audit and Feedback: Effects on Professional Practice
Article
Article Title | Audit and Feedback: Effects on Professional Practice |
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ERA Journal ID | 15305 |
Article Category | Article |
Authors | Ivers, Noah, Yogasingam, Sharlini, Lacroix, Meagan, Brown, Kevin A, Antony, Jesmin, Soobiah, Charlene, Simeoni, Michelle, Willis, Thomas A, Crawshaw, Jacob, Antonopoulou, Vivi, Meyer, Carly, Solbak, Nathan M, Murray, Brenna J, Butler, Emily-Ann, Lepage, Simone, Giltenane, Martina, Carter, Mary D, Fontaine, Guillaume, Sykes, Michael, Halasy, Michael, Bazazo, Abdalla, Seaton, Samantha, Canavan, Tony, Alderson, Sarah, Reis, Catherine, Linklater, Stefanie, Lalor, Aislinn, Fletcher, Ashley, Gearon, Emma, Jenkins, Hazel, Wallis, Jason A, Grobler, Liesl, Beccaria, Lisa, Cyril, Sheila, Rozbroj, Tomas, Han, Jia Xi, Xu, Alice XT, Wu, Kelly, Rouleau, Geneviève, Shah, Maryam, Konnyu, Kristin, Colquhoun, Heather, Presseau, Justin, O'Connor, Denise, Lorencatto, Fabiana and Grimshaw, Jeremy M |
Journal Title | Cochrane Database of Systematic Reviews |
Journal Citation | 2025 (3) |
Article Number | CD000259 |
Number of Pages | 463 |
Year | 2025 |
Publisher | John Wiley & Sons |
Place of Publication | United Kingdom |
ISSN | 1469-493X |
1361-6137 | |
Digital Object Identifier (DOI) | https://doi.org/10.1002/14651858.CD000259.pub4 |
Web Address (URL) | https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000259.pub4/full |
Abstract | Background Objectives Search methods Selection criteria Data collection and analysis For studies with dichotomous outcomes that included arms with and without A&F, we calculated risk differences (RDs) (absolute difference between arms in proportion of desired practice completed) and also odds ratios (ORs). We synthesised the median RDs and interquartile ranges (IQRs) across all trials. We then conducted meta‐analyses, accounting for multiple outcomes from a given study and weighted by effective sample size, using reported (or imputed, when necessary) intra‐cluster correlation coefficients. Next, we explored the role of baseline performance, co‐interventions, targeted behaviour, and study design factors on the estimated effects of A&F. Finally, we conducted exploratory meta‐regressions to test preselected variables that might be associated with A&F effect size: characteristics of the audit (number of indicators, aggregation of data); delivery of the feedback (multi‐modal format, local champion, nature of comparator, repeated delivery); and components supporting action (facilitation, provision of specific plans for improvement, co‐development of action plans). Main results Synthesis of 558 dichotomous outcomes measuring professional practices from 177 studies testing A&F versus control revealed a median absolute improvement in desired practice of 2.7%, with an IQR of 0.0 to 8.6. Meta‐analyses of these studies, accounting for multiple outcomes from the same study and weighting by effective sample size accounting for clustering, found a mean absolute increase in desired practice of 6.2% (95% confidence interval (CI) 4.1 to 8.2; moderate‐certainty evidence) and an OR of 1.47 (95% CI 1.31 to 1.64; moderate‐certainty evidence). Effects were similar for pre‐planned subgroup analyses focused on prescribing and test‐ordering outcomes. Lower baseline performance and increased number of co‐interventions were both associated with larger intervention effects. Meta‐regressions comparing the presence versus absence of specific A&F components to explore heterogeneity, accounting for baseline performance and number of co‐interventions, suggested that A&F effects were greater with individual‐recipient‐level data rather than team‐level data, comparing performance to top‐peers or a benchmark, involving a local champion with whom the recipient had a relationship, using interactive modalities rather than just didactic or just written format, and with facilitation to support engagement, and action plans to improve performance. The meta‐regressions did not find significant effects with the number of indicators in the audit, comparison to average performance of all peers, or co‐development of action plans. Contrary to expectations, repeated delivery was associated with lower effect size. Direct comparisons from head‐to‐head trials support the use of peer‐comparisons versus no comparison at all and the use of design elements in feedback that facilitate the identification and action of high‐priority clinical items. Authors' conclusions 1. targets important performance metrics where health professionals have substantial room for improvement (audit); |
Contains Sensitive Content | Does not contain sensitive content |
ANZSRC Field of Research 2020 | 420312. Implementation science and evaluation |
Public Notes | File reproduced in accordance with the copyright policy of the publisher/author/creator. |
Byline Affiliations | Women's College Hospital, Canada |
Ottawa Hospital Research Institute, Canada | |
Public Health Ontario, Canada | |
No affiliation | |
University of Leeds, United Kingdom | |
University College London, United Kingdom | |
University of Newcastle | |
University of Calgary, Canada | |
National University of Ireland Galway, Ireland | |
University of Limerick, Ireland | |
University of Exeter, United Kingdom | |
McGill University, Canada | |
Sir Mortimer B. Davis Jewish General Hospital, Canada | |
University of New South Wales | |
Northumbria University, United Kingdom | |
A.T. Still University, United States | |
Northern Ontario School of Medicine (NOSM) University, Canada | |
Thunder Bay Regional Health Research Institute, Canada | |
Listowel Wingham Hospitals Alliance, Canada | |
University Hospital Galway, Ireland | |
University of Toronto, Canada | |
Monash University | |
Macquarie University | |
School of Nursing and Midwifery | |
Centre for Health Research | |
University of Quebec in Outaouais, Canada | |
University of Aberdeen, United Kingdom | |
University of Ottawa, Canada |
https://research.usq.edu.au/item/zwy59/audit-and-feedback-effects-on-professional-practice
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