- Email: [email protected]
Audit and feedback: Effects on professional practice and healthcare outcomes
Cochrane review abstracts
Main results In this third update, 13 randomised controlled trials were included. One, which was a study of compliance lasting 12 weeks, contributed no fracture outcome data. Five studies involving 4,316 participants were cluster randomised by care unit, nursing home or nursing home ward rather than by the individual. Individually, each of these studies reported a reduced incidence of hip fractures within those units allocated to receive the protectors. Because of the use of cluster randomisation, pooling of results of these studies was not undertaken. Pooling of data from five individually randomised trials conducted in nursing/residential care settings (1,426 participants) showed no significant reduction in hip fracture incidence (hip protectors 37/822, controls 40/604, relative risk 0.83, 95% confidence interval 0.54 to 1.29). Two individually randomised trials of 966 community dwelling participants reported no reduction in hip fracture incidence with the hip protectors (relative risk 1.11, 95% confidence interval 0.65 to 1.90). No important adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor.
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Reviewers’ conclusions There is no evidence of effectiveness of hip protectors from studies in which randomisation was by individual patients within an institution, or for those living in their own homes. Data from cluster randomised studies indicates that, for those living in institutional care with a high background incidence of hip fracture, a programme of providing hip protectors appears to reduce the incidence of hip fractures. Acceptability by users of the protectors remains a problem, due to discomfort and practicality. Cost effectiveness remains unclear. Contact address Dr Martyn Parker, Orthopaedic Research Fellow, Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire PE3 6DA Telephone 01733 874193 Fax 01733 874111 E-mail [email protected]
Audit and feedback: Effects on professional practice and healthcare outcomes G Jamtvedt, J M Young, D T Kristoffersen, M A Thomson O’Brien, A D Oxman Background Audit and feedback continue to be widely used as a strategy to improve professional practice. Logically, healthcare professionals would be prompted to modify their practice if given feedback that their clinical practice was inconsistent with that of their peers or accepted guidelines. Yet audit and feedback have not been found to be consistently effective. Objectives To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes. Search strategy We searched the Cochrane Effective Practice and Organisation of Care Group’s register up to January 2001. This was supplemented with searches of Medline and reference lists, which did not yield additional relevant studies. Selection criteria Randomised trials of audit and feedback (defined as any summary of clinical performance over a specified period of time) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. Data collection and analysis Two reviewers independently Jamtvedt, G, Young, J M, Kristoffersen, D T, Thomson O’Brien, M A and Oxman, A D (2003). ‘Audit and feedback: Effects on professional practice and health care outcomes’, The Cochrane Library, 3, Update Software, Oxford.
extracted data and assessed study quality. Quantitative (meta-regression), visual and qualitative analyses were undertaken. Main results We included 85 studies, 48 of which have been added to the previous version of this review. There were 52 comparisons of dichotomous outcomes from 47 trials with over 3,500 health professionals that compared audit and feedback to no intervention. The adjusted risk differences of non-compliance with desired practice varied from 0.09 (a 9% absolute increase in non-compliance) to 0.71 (a 71% decrease in non-compliance) (median = 0.07, inter-quartile range = 0.02 to 0.11). The one factor that appeared to predict the effectiveness of audit and feedback across studies was baseline non-compliance with recommended practice. Reviewers’ conclusions Audit and feedback can be effective in improving professional practice. When it is effective, the effects are generally small to moderate. The absolute effects of audit and feedback are more likely to be larger when baseline adherence to recommended practice is low. Contact address Gro Jamtvedt, Director, Department for Research Dissemination and Support, Norwegian Directorate for Health and Social Welfare, Pb 8054 Dep, Oslo N-0031, Norway. Telephone +47 24 16 32 70 Fax +47 24 16 30 03 E-mail [email protected] Physiotherapy September 2003/vol 89/no 9
Main results In this third update, 13 randomised controlled trials were included. One, which was a study of compliance lasting 12 weeks, contributed no fracture outcome data. Five studies involving 4,316 participants were cluster randomised by care unit, nursing home or nursing home ward rather than by the individual. Individually, each of these studies reported a reduced incidence of hip fractures within those units allocated to receive the protectors. Because of the use of cluster randomisation, pooling of results of these studies was not undertaken. Pooling of data from five individually randomised trials conducted in nursing/residential care settings (1,426 participants) showed no significant reduction in hip fracture incidence (hip protectors 37/822, controls 40/604, relative risk 0.83, 95% confidence interval 0.54 to 1.29). Two individually randomised trials of 966 community dwelling participants reported no reduction in hip fracture incidence with the hip protectors (relative risk 1.11, 95% confidence interval 0.65 to 1.90). No important adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor.
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Reviewers’ conclusions There is no evidence of effectiveness of hip protectors from studies in which randomisation was by individual patients within an institution, or for those living in their own homes. Data from cluster randomised studies indicates that, for those living in institutional care with a high background incidence of hip fracture, a programme of providing hip protectors appears to reduce the incidence of hip fractures. Acceptability by users of the protectors remains a problem, due to discomfort and practicality. Cost effectiveness remains unclear. Contact address Dr Martyn Parker, Orthopaedic Research Fellow, Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire PE3 6DA Telephone 01733 874193 Fax 01733 874111 E-mail [email protected]
Audit and feedback: Effects on professional practice and healthcare outcomes G Jamtvedt, J M Young, D T Kristoffersen, M A Thomson O’Brien, A D Oxman Background Audit and feedback continue to be widely used as a strategy to improve professional practice. Logically, healthcare professionals would be prompted to modify their practice if given feedback that their clinical practice was inconsistent with that of their peers or accepted guidelines. Yet audit and feedback have not been found to be consistently effective. Objectives To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes. Search strategy We searched the Cochrane Effective Practice and Organisation of Care Group’s register up to January 2001. This was supplemented with searches of Medline and reference lists, which did not yield additional relevant studies. Selection criteria Randomised trials of audit and feedback (defined as any summary of clinical performance over a specified period of time) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. Data collection and analysis Two reviewers independently Jamtvedt, G, Young, J M, Kristoffersen, D T, Thomson O’Brien, M A and Oxman, A D (2003). ‘Audit and feedback: Effects on professional practice and health care outcomes’, The Cochrane Library, 3, Update Software, Oxford.
extracted data and assessed study quality. Quantitative (meta-regression), visual and qualitative analyses were undertaken. Main results We included 85 studies, 48 of which have been added to the previous version of this review. There were 52 comparisons of dichotomous outcomes from 47 trials with over 3,500 health professionals that compared audit and feedback to no intervention. The adjusted risk differences of non-compliance with desired practice varied from 0.09 (a 9% absolute increase in non-compliance) to 0.71 (a 71% decrease in non-compliance) (median = 0.07, inter-quartile range = 0.02 to 0.11). The one factor that appeared to predict the effectiveness of audit and feedback across studies was baseline non-compliance with recommended practice. Reviewers’ conclusions Audit and feedback can be effective in improving professional practice. When it is effective, the effects are generally small to moderate. The absolute effects of audit and feedback are more likely to be larger when baseline adherence to recommended practice is low. Contact address Gro Jamtvedt, Director, Department for Research Dissemination and Support, Norwegian Directorate for Health and Social Welfare, Pb 8054 Dep, Oslo N-0031, Norway. Telephone +47 24 16 32 70 Fax +47 24 16 30 03 E-mail [email protected] Physiotherapy September 2003/vol 89/no 9