Study Reports on Improving Audit and Feedback Strategies
Audit and feedback (A&F) has long been used to change provider behavior, thereby improving the quality of healthcare. A&F furnishes providers with summaries of clinical performance over a specified period of time, offering providers current information and motivation to improve. A&F has gained renewed attention due to its role in the effectiveness of physician-based performance measurement and pay-for-performance initiatives. This meta-analysis of 19 studies sought to determine A&F characteristics that 1) positively impact provider performance, 2) shift the locus of attention toward the details of the task so that the effect of A&F will enhance performance, and 3) shift the locus of attention away from details that will attenuate the effect of A&F on performance.
Study findings show that A&F has a modest but significant positive effect on quality outcomes. A&F reports containing specific suggestions for performance improvements - delivered in writing, rather than verbally or graphically, and delivered frequently - can noticeably improve the effectiveness of audit and feedback. Also, providing combined group- and individual-level feedback appeared to positively impact feedback effectiveness; however, definitive conclusions could not be made.
Hysong S. Meta-analysis: Audit and feedback features impact effectiveness on care quality. Medical Care March 2009;47(3):356-363.
This study was partly funded by HSR&D. Dr. Hysong is part of HSR&D's Houston Center for Quality of Care and Utilization Studies.