Background 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. Objectives To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes. Search strategy 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. Selection criteria 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. Data collection and analysis Two reviewers independently extracted data and assessed study quality. Quantitative (meta-regression), visual and qualitative analyses were undertaken. Main results 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.

Audit and feedback: effects on professional practice and healthcare outcomes

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结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

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Background
Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not.

Objectives
To assess the effects of educational meetings on professional practice and healthcare outcomes.

Search methods
We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006.

Selection criteria
Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes.

Data collection and analysis
Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots.

Main results
In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes.

Authors' conclusions
Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.

Continuing education meetings and workshops: effects on professional practice and health care outcomes

/pdf/about-the-national-institute-for-health-and-care-excellence-4zmiguft2a.pdf

About the National Institute for Health and Care Excellence - NICE.

EDITOR—Sheldon et al show a gradual reduction in the number of wisdom teeth extractions, which they propose indicates a diffusion of guidance from the National Institute for Clinical Excellence (NICE) into clinical dental practice.1 The first figure in our response on bmj.com shows the annual number of courses of treatment that included at least one extraction of the third molar in the General Dental Service in Scotland.2 This figure corresponds to the presentation of data in figure 1 of Sheldon et al's paper.1

The raw number of claims per …

/pdf/what-s-the-evidence-that-nice-guidance-has-been-implemented-5gehhyk569.pdf

What's the evidence that NICE guidance has been implemented? Analysis is subject to confounding.

The Effective Dental Practice Program One approach is to develop a program of research specifically dedicated to investigating the translation of knowledge into evidence– based dental practice within primary dental care services as well as dental education. The Effective Dental Practice (EDP) Program now includes a range of such studies funded by the Medical Research Council, the Chief Scientists Office, the National Institute for Health Research Health Technology Assessment, the Economic and Social Research Council and the Scottish Government. For example, the ERUPT trial examined the effect of 2 different implementation strategies to increase the adoption of effective practice recommendations in Scotland – a specific fee for service and a general education course. One–hundred and forty–nine general dental practice GDPs returned data on 2,833 children who had treatment records showing at least 1 erupted second molar. The trial demonstrated that a fee for a preventive fissure sealant would increase the number of children receiving such care by 10%. The results of this trial informed and influenced the Scottish Executive policy decision to change the fee for item of service for this particular treatment.

https://jdh.adha.org/content/jdenthyg/83/4/163.full.pdf

Jan E Clarkson

Papers

What's the evidence that NICE guidance has been implemented? Analysis is subject to confounding.

Increasing Adoption of New Innovations and Effective Practice Recommendations

Is It Time to Share Pediatric Guideline Development

P90– The translation of SDCEP Guidance on Dental Caries in Children into practice

Incentives and Public Service Performance: A Special Issue