Effect of medical record audit and feedback on residents' compliance with preventive health care guidelines.
OBJECTIVE
To examine the effect on residents' compliance with preventive health guidelines of an intensive quality-improvement program using medical record audits and individualized feedback.


METHODS
The before-and-after study was set in a general internal medicine clinic at a military teaching hospital. In 1995, the authors retrospectively reviewed 280 medical records to determine whether, after the hospital had started an audit-and-feedback program in 1994, residents' compliance rates had risen for preventive health interventions. The study looked at both audited and non-audited interventions.


RESULTS
The residents' compliance rates significantly improved for the audited interventions (tetanus immunizations, breast examination, and rectal examination). They also had higher compliance rates for six of the seven non-audited interventions.


CONCLUSIONS
An intensive medical record audit with individualized feedback can produce exceptionally high levels of compliance with preventive care practices among internal medicine residents. Furthermore, the improved compliance is generalizable to other health care measures not directly targeted for audit.
Holmboe
E
E
Robert Wood Johnson Clinical Scholar, Yale University, New Haven, USA. HolmboeES@maspo2.mas.yale.edu
Scranton
R
R
Sumption
K
K
Hawkins
R
R
D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006772:Hospitals, Military; D006801:Humans; D007396:Internship and Residency; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D014768:Virginia