Meta-analysis: audit and feedback features impact effectiveness on care quality.
BACKGROUND
Audit and feedback (A&F) has long been used to improve quality of care, albeit with variable results. This meta-analytic study tested whether Feedback Intervention Theory, a framework from industrial/organizational psychology, explains the observed variability in health care A&F research.


METHODS



METHODS
studies cited by Jamtvedt's 2006 Cochrane systematic review of A&F, followed by database searches using the Cochrane review's search strategy to identify more recent studies.


METHODS
Cochrane review criteria, plus: presence of a treatment group receiving only A & F; a control group receiving no intervention; a quantitatively measurable outcome; minimum n of 10 per arm; sufficient statistics for effect size calculations. Moderators: presence of discouragement and praise; correct solution, attainment level, velocity, frequency, and normative information; feedback format (verbal, textual, graphic, public, computerized, group vs. individual); goal setting activity.


METHODS
meta-analytic procedures using the Hedges-Olkin method.


RESULTS
Of 519 studies initially identified, 19 met all inclusion criteria. Studies were most often excluded due to the lack of a feedback-only arm. A&F has a modest, though significant positive effect on quality outcomes (d = 0.40, 95% confidence interval = +/-0.20); providing specific suggestions for improvement, written, and more frequent feedback strengthened this effect, whereas graphical and verbal feedback attenuated this effect.


CONCLUSIONS
A&F effectiveness is improved when feedback is delivered with specific suggestions for improvement, in writing, and frequently. Other feedback characteristics could also potentially improve effectiveness; however, research with stricter experimental controls is needed to identify the specific feedback characteristics that maximize its effectiveness.
Hysong
Sylvia J
SJ
Houston VA HSR&D Center of Excellence, Health Services Research & Development Service, Department of Veterans Affairs Medical Center, TX, USA. hysong@bcm.tmc.edu
D005246:Feedback; D006302:Health Services Research; D006801:Humans; D008485:Medical Audit; D011590:Psychology, Industrial; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic