Professional Intervention: Audit and Feedback

Definition: Any summary of clinical performance of health care over a specified period of time. The summary may also have included recommendations for clinical action. The information may have been obtained from medical records, computerized databases, or observations from patients.

Effectiveness: One high quality review (Jamtvedt) and three key reviews (Arnold, Davey, Shaw) were identified. One high quality review (Jamtvedt) found audit and feedback used alone or in combination with other interventions to be generally effective for appropriate care and precribing outcomes. One key review (Davey) found audit and feedback to be generally effective for appropriate care but had an insufficient number of studies to draw conclusions for prescribing outcomes. Two key reviews (Arnold, Shaw) had an insufficient number of studies to draw any conclusions about the intervention.

Summary of Overall Findings from Reviews: 2/2 high quality/key reviews with a sufficient number of studies to draw conclusions found this intervention to be generally effective.

Summary of Findings Related to Prescribing: 1/1 high quality/key reviews with a sufficient number of studies to draw conclusions found this intervention to be generally effective for improving prescribing outcomes.

Reviews Addressing This Intervention Quality Assessment Tool:
AMSTAR Score (of 11 points)
Jamtvedt G, Kristoffersen DT, O'Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2006 (2):CD000259. 8 (High)
Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database of Systematic Reviews 2005 (4):CD003539. 7 (Medium)
Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, Holmes A, Ramsay C, Taylor E, Wilcox M, Wiffen P. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews 2005 (4):CD003543. 7 (Medium)
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C. Effectiveness and efficiency of guideline dissemination and implementation strategies. 2004 8 (6):iii-72. 7 (Medium)
Marinopoulos SS, Dorman T, Ratanawongsa N, Wilson LM, Ashar BH, Magaziner JL, Miller RG, Thomas PA, Prokopowicz GP, Qayyum R, Bass EB. Effectiveness of continuing medical education. Evidence Report — Technology Assessment (Full Rep) 2007 (149):1-69. 7 (Medium)
Shaw B, Cheater F, Baker R, Gillies C, Hearnshaw H, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2005 (3):CD005470. 7 (Medium)
Smith SM, Allwright S, O'Dowd T. Does sharing care across the primary-specialty interface improve outcomes in chronic disease? A systematic review. American Journal of Managed Care 2008 14 (4):213-224. 7 (Medium)
Bywood PT, Lunnay B, Roche AM. Strategies for facilitating change in alcohol and other drugs (AOD) professional practice: a systematic review of the effectiveness of reminders and feedback. Drug and Alcohol Review 2008 27 (5):548-558. 6 (Medium)
Ranji SR, Steinman MA, Shojania KG, Gonzales R. Interventions to reduce unnecessary antibiotic prescribing: a systematic review and quantitative analysis. Medical Care 2008 46 (8):847-862. 6 (Medium)
Balas EA, Boren SA, Brown GD, Ewigman BG, Mitchell JA, Perkoff GT. Effect of physician profiling on utilization. Meta-analysis of randomized clinical trials. Journal of General Internal Medicine 1996 11 (10):584-590. 5 (Medium)
Bordley WC, Chelminski A, Margolis PA, Kraus R, Szilagyi PG, Vann JJ. The effect of audit and feedback on immunization delivery. American Journal of Preventive Medicine 2000 18 (4):343-350. 5 (Medium)
Dijkstra R, Wensing M, Thomas R, Akkermans R, Braspenning J, Grimshaw J, Grol R. The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis. BMC Health Services Research 2006 28 (6):53-53. 5 (Medium)
Haynes RB, Davis DA, McKibbon A, Tugwell P. A critical appraisal of the efficacy of continuing medical education. Journal of the American Medical Association 1984 251 (1):61-64. 5 (Medium)
Hysong SJ. Meta-analysis: audit and feedback features impact effectiveness on care quality. Medical Care 2009 47 (3):356-363. 5 (Medium)
Safdar N, Abad C. Educational interventions for prevention of healthcare-associated infection: a systematic review. Critical Care Medicine 2008 36 (3):933-940. 5 (Medium)
Solomon DH, Hashimoto H, Daltroy L, Liang MH. Techniques to improve physicians' use of diagnostic tests: a new conceptual framework. Journal of the American Medical Informatics Association 1998 280 (23):2020-2027. 5 (Medium)
Steinman MA, Ranji SR, Shojania KG, Gonzales R. Improving antibiotic selection: a systematic review and quantitative analysis of quality improvement strategies. 2006 44 (7):617-628. 5 (Medium)
Weinmann S, Koesters M, Becker T. Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review. Acta Psychiatrica Scandinavica 2007 115 (6):420-433. 5 (Medium)
Wilson K, MacDougall L, Fergusson D, Graham I, Tinmouth A, Hebert PC. The effectiveness of interventions to reduce physician's levels of inappropriate transfusion: what can be learned from a systematic review of the literature. Transfusion 2002 42 (9):1224-1229. 5 (Medium)
Yourman L, Concato J, Agostini JV. Use of computer decision support interventions to improve medication prescribing in older adults: a systematic review. American Journal of Geriatric Pharmacotherapy 2008 6 (2):119-129. 5 (Medium)
Anderson L, Janes GR, Jenkins C. Implementing preventive services: to what extent can we change provider performance in ambulatory care? a review of the screening, immunization, and counselling literature. Annals of Behavioral Medicine 1996 20 (3):161-167. 4 (Medium)
Bennett JW, Glasziou PP. Computerised reminders and feedback in medication management: a systematic review of randomized controlled trials. 2003 178 (5):217-222. 4 (Medium)
Bertram DA, Brooks-Bertram PA. The evaluation of continuing medical education: a literature review. Health Education Monographs 1977 5 (4):330-353. 4 (Medium)
Chaillet N, Dubé E, Dugas M, Audibert F, Tourigny C, Fraser WD, Dumont A. Evidence-based strategies for implementing guidelines in obstetrics: a systematic review. Obstetrics and Gynecology 2006 108 (5):1234-1245. 4 (Medium)
Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine 2006 144 :E-12-E-22. 4 (Medium)
Figueiras A, Sastre I, Gestal-Otero JJ. Effectiveness of educational interventions on the improvement of drug prescription in primary care: a critical literature review. Journal of Evaluation in Clinical Practice 2001 7 (2):223-241. 4 (Medium)
Guldberg TL, Lauritzen T, Kristensen JK, Vedsted P. The effect of feedback to general practitioners on quality of care for people with type 2 diabetes. A systematic review of the literature. BMC Family Practice 2009 10 4 (Medium)
Naikoba S, Hayward A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers — a systematic review. Journal of Hospital Infection 2001 47 (3):173-180. 4 (Medium)
Ostini R, Hegney D, Jackson C, Williamson M, Mackson JM, Gurman K, Hall W, Tett SE. Systematic review of interventions to improve prescribing. Annals of Pharmacotherapy 2009 43 (3):502-513. 4 (Medium)
Sabatino SA, Habarta N, Baron RC, Coates RJ, Rimer BK, Kerner J, Coughlin SS, Kalra GP, Chattopadhyay S, Task Force on Community Preventive Services. Interventions to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers systematic reviews of provider assessment and feedback and provider incentives. American Journal of Preventative Medicine 2008 35 (1):S67-S74. 4 (Medium)
van Steenkiste B, Grol R, van der Weijden T. Systematic review of implementation strategies for risk tables in the prevention of cardiovascular diseases. Vascular Health and Risk Management 2008 4 (3):535-545. 4 (Medium)
Wensing M, Grol R. Single and combined strategies for implementing changes in primary care: a literature review. International Journal for Quality in Health Care 1994 6 (2):115-132. 4 (Medium)