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. 2022 Mar 21;3(1):32.
doi: 10.1186/s43058-022-00275-5.

Opportunities to improve the impact of two national clinical audit programmes: a theory-guided analysis

T A Willis  1 , S Wood  2 , J Brehaut  3   4 , H Colquhoun  5 , B Brown  6   7 , F Lorencatto  8 , R Foy  2
Affiliations

Opportunities to improve the impact of two national clinical audit programmes: a theory-guided analysis

T A Willis et al. Implement Sci Commun. .

Abstract

Background: Audit and feedback is widely used in healthcare improvement, with evidence of modest yet potentially important effects upon professional practice. There are approximately 60 national clinical audit programmes in the UK. These programmes often develop and adapt new ways of delivering feedback to optimise impacts on clinical practice. Two such programmes, the National Diabetes Audit (NDA) and the Trauma Audit Research Network (TARN), recently introduced changes to their delivery of feedback. We assessed the extent to which the design of these audit programmes and their recent changes were consistent with best practice according to the Clinical Performance Feedback Intervention Theory (CP-FIT). This comprehensive framework specifies how variables related to the feedback itself, the recipient, and the context operate via explanatory mechanisms to influence feedback success.

Methods: We interviewed 19 individuals with interests in audit and feedback, including researchers, audit managers, healthcare staff, and patient and public representatives. This range of expert perspectives enabled a detailed exploration of feedback from the audit programmes. We structured interviews around the CP-FIT feedback cycle and its component processes (e.g. Data collection and analysis, Interaction). Our rapid analytic approach explored the extent to which both audits applied features consistent with CP-FIT.

Results: Changes introduced by the audit programmes were consistent with CP-FIT. Specifically, the NDA's increased frequency of feedback augmented existing strengths, such as automated processes (CP-FIT component: Data collection and analysis) and being a credible source of feedback (Acceptance). TARN's new analytic tool allowed greater interactivity, enabling recipients to interrogate their data (Verification; Acceptance). We also identified scope for improvement in feedback cycles, such as targeting of feedback recipients (Interaction) and feedback complexity (Perception) for the NDA and specifying recommendations (Intention) and demonstrating impact (Clinical performance improvement) for TARN.

Conclusions: The changes made by the two audit programmes appear consistent with suggested best practice, making clinical improvement more likely. However, observed weaknesses in the feedback cycle may limit the benefits of these changes. Applying CP-FIT via a rapid analysis approach helps identify strengths and remediable weaknesses in the design of audit programmes that can be shared with them in a timely manner.

Keywords: Audit and feedback; CP-FIT; Clinical audit; Qualitative.

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Conflict of interest statement

Thomas Willis, Jamie Brehaut, Heather Colquhoun, Benjamin Brown, Fabiana Lorencatto, and Robbie Foy are members of the Audit and Feedback MetaLab. The MetaLab is an international collaboration to advance learning and expertise on audit and feedback. Su Wood reports grants from the National Institute of Health Research and West Yorkshire Research and Development Research Capability Funding during the conduct of the study, as well as grants from the Royal College of General Practitioners and National Institute of Health Research outside the submitted work. Fabiana Lorencatto reports grants from the National Institute of Health Research during the conduct of the study. Robbie Foy reports grants from the National Institute of Health Research during the conduct of the study. He was a member of a sub-panel for the National Institute of Health Research Programme Grants for Applied Research.

Figures

Fig. 1
Fig. 1
Clinical Performance Feedback Intervention Theory’s variables and explanatory mechanisms and their influence on the feedback cycle. Solid arrows are the necessary pathways for successful feedback; dotted arrows represent the potential pathways [4]
See this image and copyright information in PMC

References

    1. Foy R, Skrypak M, Alderson S, Ivers NM, McInerney B, Stoddart J, et al. Revitalising audit and feedback to improve patient care. BMJ. 2020;368:m213. doi: 10.1136/bmj.m213. - DOI - PMC - PubMed
    1. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;(6):CD000259. 10.1002/14651858.CD000259.pub3. - PMC - PubMed
    1. Colquhoun HL, Brehaut JC, Sales A, Ivers N, Grimshaw J, Michie S, et al. A systematic review of the use of theory in randomized controlled trials of audit and feedback. Implement Sci. 2013;8(1):1–8. doi: 10.1186/1748-5908-8-66. - DOI - PMC - PubMed
    1. Brown B, Gude WT, Blakeman T, van der Veer SN, Ivers N, Francis JJ, et al. Clinical Performance Feedback Intervention Theory (CP-FIT): a new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research. Implement Sci. 2019;14(1):40. doi: 10.1186/s13012-019-0883-5. - DOI - PMC - PubMed
    1. NHS Digital. National Diabetes Audit Programme 2020 [updated 25 November 2020. Available from: https://digital.nhs.uk/data-and-information/clinical-audits-and-registri.... Accessed 19 Aug 2021.