Jamtvedt G, Young J M, Kristoffersen D T, Thomson O'Brien M A, Oxman A D
Departement for Research Dissemination and Support, Norwegian Directorate for Health and Social Welfare, Pb. 8054 Dep, Oslo, Norway, N-0031.
Cochrane Database Syst Rev. 2003(3):CD000259. doi: 10.1002/14651858.CD000259.
Audit and feedback continues to be widely used as a strategy to improve professional practice. It appears logical that 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 has not been found to be consistently effective.
To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes.
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.
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.
Two reviewers independently extracted data and assessed study quality. Quantitative (meta-regression), visual and qualitative analyses were undertaken.
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 3500 health professionals that compared audit and feedback to no intervention. The adjusted RDs 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.
REVIEWER'S 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.
审核与反馈作为一种改善专业实践的策略仍被广泛使用。如果医疗保健专业人员得到反馈，指出其临床实践与同行或公认指南不一致，他们似乎会合乎逻辑地被促使改变自己的实践。然而，审核与反馈并未被发现始终有效。
评估审核与反馈对医疗保健专业人员的实践及患者结局的影响。
我们检索了截至2001年1月的Cochrane有效实践与护理组织小组登记册。并补充检索了MEDLINE及参考文献列表，但未获得其他相关研究。
审核与反馈的随机试验（定义为特定时间段内临床绩效的任何总结），其报告了在医疗环境中客观测量的专业实践或医疗保健结局。
两名综述作者独立提取数据并评估研究质量。进行了定量（meta回归）、可视化和定性分析。
我们纳入了85项研究，其中48项已添加到本综述的上一版本中。47项试验中有52项二分结局比较，涉及3500多名医疗保健专业人员，将审核与反馈与无干预进行了比较。未遵循期望实践的调整风险差从0.09（未遵循率绝对增加9%）到0.71（未遵循率降低71%）不等（中位数 = 0.07，四分位间距 = 0.02至0.11）。在各项研究中，似乎能预测审核与反馈有效性的一个因素是基线时未遵循推荐实践的情况。
审核与反馈可有效改善专业实践。当其有效时，效果通常较小至中等。当基线时对推荐实践的依从性较低时，审核与反馈的绝对效果更可能更大。
Zotero 插件