O'Brien M A, Oxman A D, Davis D A, Haynes R B, Freemantle N, Harvey E L
Juravinski Cancer Centre, Supportive Cancer Care Research Unit, 699 Concession Street, Hamilton, Ontario, Canada, L8V 5C2. maryann.o'
Cochrane Database Syst Rev. 2007 Jul 18(1):CD000260. doi: 10.1002/14651858.CD000260.
Audit and feedback has been identified as having the potential to change the practice of health care professionals.
To assess the effects of audit and feedback compared with other interventions in changing health professional practice and to assess whether the effectiveness of audit and feedback can be improved by modifying how it is done.
We searched MEDLINE up to June 1997, the Research and Development Resource Base in Continuing Medical Education, and reference lists of related systematic reviews and articles.
Randomised trials of audit and feedback (defined as any summary of clinical performance of health care over a specified period of time) compared with other interventions. The participants were health care providers responsible for patient care.
Two reviewers independently extracted data and assessed study quality.
Twelve studies were included involving more than 2194 physicians. Seven trials with direct comparisons were included. The targeted behaviours were the management of low haemoglobin, the delivery of preventive care services (two studies), the management of high cholesterol, the performance of cervical smears, and the ordering of diagnostic tests (two studies). From the results of four trials, there is little evidence of a measurable effect of adding a complementary intervention such as a local consensus process to audit and feedback compared to audit and feedback alone. Two of three trials that compared audit and feedback to reminders reported that reminders were more effective in improving the delivery of some preventive services.
AUTHORS' CONCLUSIONS: It is not possible to recommend a complementary intervention to enhance the effectiveness of audit and feedback. Reminders might be more effective than audit and feedback to improve the delivery of some preventive services but the results are not striking. Few trials have investigated the effect of varying different characteristics of the audit and feedback process. Consideration should be given to testing the effects of modifying important characteristics such as the content, source, timing, recipient and format.
审核与反馈已被认为有可能改变医疗保健专业人员的行为。
评估审核与反馈与其他干预措施相比在改变医疗专业人员行为方面的效果，并评估通过改变审核与反馈的实施方式是否可以提高其有效性。
我们检索了截至1997年6月的MEDLINE、继续医学教育研究与发展资源库以及相关系统评价和文章的参考文献列表。
审核与反馈（定义为特定时间段内医疗保健临床绩效的任何总结）与其他干预措施相比的随机试验。参与者为负责患者护理的医疗保健提供者。
两名评价员独立提取数据并评估研究质量。
纳入了12项研究，涉及2194多名医生。纳入了7项直接比较的试验。目标行为包括低血红蛋白的管理、预防性护理服务的提供（两项研究）、高胆固醇的管理、宫颈涂片检查的执行以及诊断检查的开具（两项研究）。从四项试验的结果来看，几乎没有证据表明与单独的审核与反馈相比，在审核与反馈中添加诸如局部共识过程等补充干预措施有可测量的效果。三项将审核与反馈与提醒进行比较的试验中有两项报告称，提醒在改善某些预防性服务的提供方面更有效。
无法推荐一种补充干预措施来提高审核与反馈的有效性。提醒在改善某些预防性服务的提供方面可能比审核与反馈更有效，但结果并不显著。很少有试验研究审核与反馈过程中不同特征变化的影响。应考虑测试改变重要特征（如内容、来源、时间、接受者和形式）的效果。
