Audit and feedback: effects on professional practice and health care outcomes.
BACKGROUND
Audit and feedback has been identified as having the potential to change the practice of health care professionals.


OBJECTIVE
To assess the effects of audit and feedback on the practice of health professionals and patient outcomes.


METHODS
We searched MEDLINE up to June 1997, the Research and Development Resource Base in Continuing Medical Education, and reference lists of related systematic reviews and articles.


METHODS
Randomised trials of audit and feedback (defined as any summary of clinical performance of health care over a specified period of time). The participants were health care professionals responsible for patient care.


METHODS
Two reviewers independently extracted data and assessed study quality.


RESULTS
Thirty-seven studies were included, involving more than 4977 physicians. The reporting of study methods was inadequate for almost all studies. In 31 out of 37 studies the randomisation process could not be determined. Information regarding data analysis was also lacking. For example, power calculations were not mentioned in 27 out of 37 studies. A variety of behaviours were targeted including the reduction of diagnostic test ordering, prescribing practices, preventive care, and the general management of a problem, for example hypertension. Twenty-eight studies measured physician performance, one study targeted patient outcomes in diabetes and the remaining eight studies measured both physician performance and patient outcomes. The relative percentage differences ranged from -16% to 152%. The clinical importance of the changes was not always clear.


CONCLUSIONS
Audit and feedback can sometimes be effective in improving the practice of health care professionals, in particular prescribing and diagnostic test ordering. When it is effective, the effects appear to be small to moderate but potentially worthwhile. Those attempting to enhance professional behaviour should not rely solely on this approach.
Thomson O'Brien
M A
MA
McMaster Evidence-based Practice Centre, McMaster University, Department of Clinical Epidemiology and Biostatistics, HSC 3H7, Hamilton, Ontario, Canada, L8N 3Z5. maobrien@fhs.mcmaster.ca
Oxman
A D
AD
Davis
D A
DA
Haynes
R B
RB
Freemantle
N
N
Harvey
E L
EL
D004502:Education, Medical, Continuing; D005246:Feedback; D006282:Health Personnel / Q000592:standards; D006302:Health Services Research; D006801:Humans; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011364:Professional Practice / Q000592:standards*