Improving Healthcare Quality: The Effectiveness of Audit and Feedback

Audit and feedback improves healthcare professional performance by small to moderate amounts, according to a review of 292 studies. The process involves measuring a provider’s professional practice against established standards and returning those results to the provider to encourage clinical changes.

The review, which analyzed data up to June 2020, found that this method is frequently used by healthcare organizations to raise the quality of care. It targets various areas of practice, including how doctors order tests and the way they use prescription treatments.

How does audit and feedback work in healthcare?

The process consists of two distinct phases: the audit and the feedback. During the audit phase, an individual’s professional performance is measured and compared to specific professional standards or targets.

In the feedback phase, the results of that comparison are provided back to the health professional. The review states the aim of this process is to encourage providers to take action or change their behavior to align with professional standards.

The delivery of this feedback varies. Some providers receive information verbally, while others use written reports or electronic dashboards. Some receive feedback once, while others are monitored on a monthly basis.

What makes audit and feedback more effective?

Not all audit and feedback interventions produce the same results. The review found that specific features are associated with greater improvements in quality of care.

Performance gains are more likely when providers can see how their own results compare to high-performing peers. The data suggests that focusing on high-priority clinical issues where the professional has substantial room for improvement also increases effectiveness.

The review identified several structural factors that drive better outcomes:

• Measuring the individual recipient’s practice rather than the performance of a team or an entire organization.
• Providing feedback from a respected peer who has an existing relationship with the recipient.
• Using multiple delivery methods, such as combining verbal and written feedback.
• Including an action plan that offers specific advice on how to improve.

Can other strategies increase the impact?

Audit and feedback is rarely used in isolation. The review noted that it is often paired with other quality-improvement strategies to enhance results.

Combining feedback with educational meetings or automated reminders can make the intervention more helpful. These supports provide the training or prompts necessary for a provider to implement the changes suggested by the audit results.

What are the limitations of the current evidence?

The review analyzed 292 studies, most of which focused on doctors, though some included nurses and pharmacists. Despite the volume of studies, the overall quality of the evidence is classified as moderate.

Researchers indicated that further study is required to confirm which specific features of audit and feedback work best in different clinical situations. The evidence used in this analysis is current through June 2020.