title: Audit and feedback interventions to improve endoscopist performance: Principles and effectiveness.
abstract: There is considerable variation in the quality of colonoscopy, attributable in part to endoscopist performance. Audit and feedback (A&F) provides health professionals with a summary of their performance over a period of time and is a common strategy used to improve provider performance. In this review, we discuss current understanding of the mechanism of A&F and describe specific features of effective A&F. To date, trials of A&F to improve colonoscopy performance report heterogeneous results, in part because colonoscopy is a complex procedural skill but also because the quality improvement interventions were sub-optimally implemented or inadequately evaluated. Nonetheless, evidence from a wide range of literature suggests that A&F has the potential to improve endoscopist performance. We discuss future directions for research in this area and provide guidance for providers or health system planners wishing to implement A&F to address quality of colonoscopy in their practice and/or jurisdiction.
authors.affiliation: ColonCancerCheck Program, Cancer Care Ontario, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room HG40, Toronto, ON M4N 3M5, Canada. Electronic address: Jill.Tinmouth@sunnybrook.ca.
authors.forename: Jill
authors.initials: J
authors.lastname: Tinmouth
authors.affiliation: Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room HG40, Toronto, ON M4N 3M5, Canada. Electronic address: jigisha.patel@sunnybrook.ca.
authors.forename: Jigisha
authors.initials: J
authors.lastname: Patel
authors.affiliation: Departments of Medicine/Community Health Sciences, Cummings School of Medicine, University of Calgary, 3280 Hospital Drive NW, Room 6E17, TRW Building, Calgary, AB T2N 4Z6, Canada; Forzani & MacPhail Colon Cancer Screening Center, Alberta Health Services, Canada. Electronic address: rhilsden@ucalgary.ca.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hilsden
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Canada; Women's College Hospital, 77 Grenville Street, Toronto, ON M5S 1B3, Canada. Electronic address: noah.ivers@utoronto.ca.
authors.forename: Noah
authors.initials: N
authors.lastname: Ivers
authors.affiliation: Cancer Screening, Prevention & Cancer Control, Cancer Care Ontario, 505 University Ave, 18-37, Toronto, ON M5G 1X3, Canada. Electronic address: Diego.Llovet@cancercare.on.ca.
authors.forename: Diego
authors.initials: D
authors.lastname: Llovet
mesh_terms: D003113:Colonoscopy / Q000592:standards*; D005246:Feedback; D006801:Humans; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement
keywords: Audit & feedback; Colonoscopy; Quality improvement