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Meta-Analysis
. 2009 Mar;47(3):356-63.
doi: 10.1097/MLR.0b013e3181893f6b.

Meta-analysis: audit and feedback features impact effectiveness on care quality

Sylvia J Hysong  1
Affiliations
Meta-Analysis

Meta-analysis: audit and feedback features impact effectiveness on care quality

Sylvia J Hysong. Med Care. 2009 Mar.

Abstract

Background: Audit and feedback (A&F) has long been used to improve quality of care, albeit with variable results. This meta-analytic study tested whether Feedback Intervention Theory, a framework from industrial/organizational psychology, explains the observed variability in health care A&F research.

Data source: studies cited by Jamtvedt's 2006 Cochrane systematic review of A&F, followed by database searches using the Cochrane review's search strategy to identify more recent studies.

Inclusion criteria: Cochrane review criteria, plus: presence of a treatment group receiving only A & F; a control group receiving no intervention; a quantitatively measurable outcome; minimum n of 10 per arm; sufficient statistics for effect size calculations. Moderators: presence of discouragement and praise; correct solution, attainment level, velocity, frequency, and normative information; feedback format (verbal, textual, graphic, public, computerized, group vs. individual); goal setting activity.

Procedure: meta-analytic procedures using the Hedges-Olkin method.

Results: Of 519 studies initially identified, 19 met all inclusion criteria. Studies were most often excluded due to the lack of a feedback-only arm. A&F has a modest, though significant positive effect on quality outcomes (d = 0.40, 95% confidence interval = +/-0.20); providing specific suggestions for improvement, written, and more frequent feedback strengthened this effect, whereas graphical and verbal feedback attenuated this effect.

Conclusions: A&F effectiveness is improved when feedback is delivered with specific suggestions for improvement, in writing, and frequently. Other feedback characteristics could also potentially improve effectiveness; however, research with stricter experimental controls is needed to identify the specific feedback characteristics that maximize its effectiveness.

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Figures

Figure 1
Figure 1
Study selection flow diagram.
Figure 2
Figure 2
Effect sizes and 95% confidence intervals of studies included in meta-analysis.
See this image and copyright information in PMC

References

    1. Jamtvedt G, Young JM, Kristoffersen DT, et al. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;(2):CD000259. - PubMed
    1. Karraker RJ. Knowledge of results and incorrect recall of plausible multiple-choice alternatives. Journal of Educational Psychology. 2008;58(1):11–14.
    1. Locke EA. Motivational effects of knowledge of results: Knowledge or goal setting? Journal of Applied Psychology. 1967;51(4, Pt.1):324–329. - PubMed
    1. Bentz CJ, Bayley KB, Bonin KE, et al. Provider feedback to improve 5A's tobacco cessation in primary care: a cluster randomized clinical trial. Nicotine Tob Res. 2007;9(3):341–349. - PubMed
    1. Wahlstrom R, Kounnavong S, Sisounthone B, et al. Effectiveness of feedback for improving case management of malaria, diarrhoea and pneumonia--a randomized controlled trial at provincial hospitals in Lao PDR. Trop Med Int Health. 2003;8(10):901–909. - PubMed

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