What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review

R Foy¹ , MP Eccles¹ , G Jamtvedt² , J Young³ , JM Grimshaw⁴ and R Baker⁵

¹Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom

²Department for Health Technology Assessment, Reviews and Dissemination, Norwegian Health Services Research Centre, Oslo Norway

³Surgical Outcomes Research Centre, Central Sydney Area Health Service and University of Sydney, Royal Prince Alfred Hospital, Camperdown Australia

⁴Clinical Epidemiology Programme, Ottawa Health Research Institute, Ottawa Canada

⁵Department of Health Sciences, University of Leicester Leicester, UK

author email corresponding author email

BMC Health Services Research 2005, 5:50doi:10.1186/1472-6963-5-50


Published:	13 July 2005

Abstract

Background

Improving the quality of health care requires a range of evidence-based activities. Audit and feedback is commonly used as a quality improvement tool in the UK National Health Service [NHS]. We set out to assess whether current guidance and systematic review evidence can sufficiently inform practical decisions about how to use audit and feedback to improve quality of care.

Methods

We selected an important chronic disease encountered in primary care: diabetes mellitus. We identified recommendations from National Institute for Clinical Excellence (NICE) guidance on conducting audit and generated questions which would be relevant to any attempt to operationalise audit and feedback in a healthcare service setting. We explored the extent to which a systematic review of audit and feedback could provide practical guidance about whether audit and feedback should be used to improve quality of diabetes care and, if so, how audit and feedback could be optimised.

Results

National guidance suggests the importance of securing the right organisational conditions and processes. Review evidence suggests that audit and feedback can be effective in changing healthcare professional practice. However, the available evidence says relatively little about the detail of how to use audit and feedback most efficiently.

Conclusion

Audit and feedback will continue to be an unreliable approach to quality improvement until we learn how and when it works best. Conceptualising audit and feedback within a theoretical framework offers a way forward.