title: Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes.
abstract: 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 compared with other interventions in changing health professional practice and to assess whether the effectiveness of audit and feedback can be improved by modifying how it is done.
  
  
  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) compared with other interventions. The participants were health care providers responsible for patient care.
  
  
  METHODS
  Two reviewers independently extracted data and assessed study quality.
  
  
  RESULTS
  Twelve studies were included involving more than 2194 physicians. Seven trials with direct comparisons were included. The targeted behaviours were the management of low haemoglobin, the delivery of preventive care services (two studies), the management of high cholesterol, the performance of cervical smears, and the ordering of diagnostic tests (two studies). From the results of four trials, there is little evidence of a measurable effect of adding a complementary intervention such as a local consensus process to audit and feedback compared to audit and feedback alone. Two of three trials that compared audit and feedback to reminders reported that reminders were more effective in improving the delivery of some preventive services.
  
  
  CONCLUSIONS
  It is not possible to recommend a complementary intervention to enhance the effectiveness of audit and feedback. Reminders might be more effective than audit and feedback to improve the delivery of some preventive services but the results are not striking. Few trials have investigated the effect of varying different characteristics of the audit and feedback process. Consideration should be given to testing the effects of modifying important characteristics such as the content, source, timing, recipient and format.
authors.affiliation: McMaster Evidence-based Practice Centre, McMaster University, Department of Clinical Epidemiology and Biostatistics, HSC 3H7, Hamilton, Ontario, Canada, L8N 3Z5. maobrien@fhs.mcmaster.ca
authors.forename: M A
authors.initials: MA
authors.lastname: Thomson O'Brien
authors.forename: A D
authors.initials: AD
authors.lastname: Oxman
authors.forename: D A
authors.initials: DA
authors.lastname: Davis
authors.forename: R B
authors.initials: RB
authors.lastname: Haynes
authors.forename: N
authors.initials: N
authors.lastname: Freemantle
authors.forename: E L
authors.initials: EL
authors.lastname: Harvey
mesh_terms: D004502:Education, Medical, Continuing; D005246:Feedback; 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*