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Audit and feedback: effects on professional practice
Noah Ivers1, Sharlini Yogasingam2, Meagan Lacroix3
1Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada.
The Cochrane Database of Systematic Reviews
|June 22, 2026
Summary
Audit and feedback (A&F) improves healthcare professional practice, with an average increase of 6.2% in desired practices. Effectiveness is enhanced when A&F targets areas with room for improvement and involves individual-level data, local champions, and interactive feedback methods.
Area of Science:
- Healthcare quality improvement
- Medical education and practice
- Health services research
Background:
- Audit and feedback (A&F) is a common strategy to enhance healthcare professional practice.
- Behavioral theories suggest A&F prompts practice modification when performance deviates from targets.
- Uncertainty exists regarding A&F's overall impact and the characteristics driving its effectiveness.
Purpose of the Study:
- To evaluate the impact of audit and feedback (A&F) on healthcare professional practices.
- To identify factors influencing the variability in A&F effectiveness.
Main Methods:
- Updated systematic review and meta-analysis of randomized trials (2010-2020) assessing A&F interventions.
- Data extraction included intervention characteristics, behavior change techniques, and risk of bias.
- Meta-analyses calculated risk differences and odds ratios; meta-regressions explored heterogeneity.
Main Results:
- Included 292 studies with 678 arms; 133 (46%) had low risk of bias.
- A&F resulted in a 6.2% mean absolute increase in desired professional practice (moderate-certainty evidence).
- Effectiveness was greater with individual-level data, comparison to top peers/benchmarks, local champions, interactive feedback, and facilitation.
Conclusions:
- Audit and feedback (A&F) is effective in improving professional practice, with significant variation in effect size.
- A&F interventions are often combined with co-interventions, potentially adding to the overall effect.
- Optimizing A&F involves targeting areas with improvement potential, using individual data, local champions, interactive feedback, and actionable plans.
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