Abstract

CONTEXT
Audit and feedback (A&F) is a commonly used method in healthcare. Previous studies, particularly in the field of behavioural theories, suggest that this method encourages healthcare professionals to modify their practice. However, current evidence in healthcare does not clearly establish whether this method is associated with improvements in practice or which types of A&F are the most effective.

CLINICAL QUESTION
What are the effects of A&F on healthcare professional practice, and which factors may explain variations in the effectiveness of A&F ?

BOTTOM LINE
A&F probably improves the quality of practice, prescribing, and the ordering of additional tests (moderate-certainty evidence). Evidence suggests that A&F is more effective when the audit focuses on an individual professional’s practice or on a single behaviour rather than on the whole team or a series of actions. Feedback has greater impact when delivered by a respected peer with an existing relationship with the professional and when there is substantial room for improvement. Comparing a professional’s performance with that of higher-performing peers and focusing on issues recognised as priorities by professionals may improve the effectiveness of A&F.

Several factors appear to increase the effectiveness of A&F: feedback delivered both verbally and in writing, the addition of an action plan alongside defined objectives, and feedback combined with other strategies such as training sessions, seminars, discussion groups, or regular reminders. In contrast, combining A&F with financial incentives or using it for punitive tone appears to be less effective or even
counter-productive.

CAVEATS
The authors reported substantial heterogeneity in the effects observed. In some studies, A&F was associated with a decline in performance and difficulties in maintaining improvements over time. This highlights that A&F is not a trivial managerial intervention. Future studies are needed to better understand when and how this intervention should be used.