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Meta-analysis: audit and feedback features impact effectiveness on care quality.
1Houston VA HSR&D Center of Excellence, Health Services Research & Development Service, Department of Veterans Affairs Medical Center, TX, USA. hysong@bcm.tmc.edu
Medical Care
|February 6, 2009
Summary
Audit and feedback (A&F) improves healthcare quality, especially when feedback is specific, written, and frequent. This meta-analysis confirms A&F's modest positive effect, guiding future quality improvement strategies.
Area of Science:
- Healthcare Quality Improvement
- Health Services Research
- Meta-Analysis
Background:
- Audit and feedback (A&F) is a widely used quality improvement strategy with variable effectiveness.
- This study investigates the applicability of Feedback Intervention Theory to explain variability in A&F research outcomes.
- The research synthesizes existing evidence on A&F's impact on healthcare quality.
Purpose of the Study:
- To meta-analytically test Feedback Intervention Theory's explanatory power for healthcare audit and feedback.
- To quantify the overall effect of A&F on quality of care outcomes.
- To identify specific characteristics of A&F that moderate its effectiveness.
Main Methods:
- Systematic search of studies from Jamtvedt's 2006 Cochrane review and updated searches.
- Inclusion criteria included specific A&F and control group designs, measurable outcomes, and sufficient sample sizes.
- Hedges-Olkin method was used for meta-analytic procedures.
Main Results:
- Nineteen studies met inclusion criteria from 519 initially identified.
- Audit and feedback demonstrated a modest, significant positive effect on quality outcomes (d = 0.40).
- Specific suggestions, written format, and frequent feedback enhanced A&F effectiveness; graphical and verbal feedback attenuated it.
Conclusions:
- Audit and feedback effectiveness is enhanced by providing specific suggestions for improvement, using written formats, and delivering feedback frequently.
- Further research with rigorous experimental controls is needed to optimize A&F characteristics.
- Findings support the targeted application of A&F strategies for improved healthcare quality.
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