Cochrane systematic review update: “Audit and feedback: effects on professional practice and patient outcomes”
Research Team:
Carly Meyer, Vivi Antonopoulou, Jake Crawshaw, Fabiana Lorencatto, Justin Presseau, Noah Ivers, & Susan Michie
Project Duration: April 2019 – July 2023
Project Outline / Summary
Audit and Feedback (A&F) is one of the most commonly used healthcare quality improvement strategies. A&F is defined as a ‘summary of clinical performance over time (audit), to provide healthcare professionals with data on performance (feedback)’. In the UK, there are over 30 established National Clinical Audits commissioned by the Healthcare Quality Improvement Partnership. These national audit programs focus on specific clinical conditions (e.g., asthma and chronic obstructive pulmonary disease; diabetes). They aim to improve care processes and patient outcomes by feeding back data to health care professionals about their clinical performance. Feedback is usually provided as a written report, and often compares an individual’s performance with either an expected standard or the average performance of their peers.
A 2012 Cochrane Review (a type of literature review that uses systematic methods to collect data from research studies) that included 140 A&F trials targeting healthcare professional practice showed that the effectiveness of A&F interventions varies and has not improved over time. It is unclear why this is. Therefore, we want to update this review by using new methods to help us understand why some A&F interventions are more effective than others. For example, it may be that A&F interventions are most successful if they incorporate specific strategies such as education, peer support, or visual reminders. This study will help us design new A&F interventions, or improve established A&F interventions, to ultimately improve care processes and patient outcomes.
Design and methods
This study will include approximately 300 trials of A&F interventions targeting health care professional practice. The overall aim of the Cochrane review update is to evaluate the effectiveness of A&F interventions. Our work within the Policy Research Unit aims to help explain why some interventions are more effective than others.
To understand why some interventions are more effective than others, we are reading the intervention descriptions of included papers, and then identifying behaviour change techniques. Behaviour change techniques refer to strategies used within interventions to change behaviour. A team of scientists have developed a list of 93 behaviour change techniques that we will use to characterize intervention content. Examples of behaviour change techniques that are common in A&F interventions include:
- Providing feedback on behaviour e.g., written feedback report
- Instruction e.g., distribution of clinical practice guidelines
- Social support e.g., regular meetings between colleagues to support one another
- Reminders to prompt behaviour e.g., posters in the clinic room that can prompt the healthcare professional to use a behaviour
Once we have identified the behaviour change techniques from intervention descriptions, we will be able to describe:
- Which and how many behaviour change techniques are reported in A&F interventions; and
- Which combination of behaviour change techniques result in more effective A&F interventions.
- These results will inform future research within the Policy Research Unit, where we hope to improve an A&F intervention and then evaluate its impact on healthcare professional behaviour.
References and Further Reading
Brehaut, J. C., Colquhoun, H. L., Eva, K. W., Carroll, K., Sales, A., Michie, S., Ivers, N., & Grimshaw, J. M. (2016). Practice feedback interventions: 15 suggestions for optimizing effectiveness [Article]. Annals of Internal Medicine, 164(6), 435-441. https://doi.org/10.7326/M15-2248
Ivers, N., Sales, A., Colquhoun, H., Michie, S., Foy, R., Francis, J., & Grimshaw, J. (2014). No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implementation Science, 9(1), 14. https://doi.org/10.1186/1748-5908-9-14
CAUTI
Interventions to decrease catheter-associated urinary tract infections
Interventions to decrease catheter-associated urinary tract infections – What behaviours need to be targeted and how?
Research Team: Carly Meyer, Vivi Antonopoulou, Aikaterini Grimani, Ivo Vlaev, & Fabiana Lorencatto
Project Outline / Summary
During hospital stays, some patients require a catheter to empty the bladder because they have difficulty urinating. A catheter is a flexible tube that is either inserted into the urethra (tube that carries urine out of the bladder) or a small opening made in the lower tummy (see https://www.nhs.uk/conditions/urinary-catheters/).
Patients can develop a urinary tract infection as a result of having a catheter, which usually needs to be treated by antibiotics. These types of infections are called catheter-associated urinary tract infections (CAUTIs). CAUTIs are the second most common type of infection acquired by adult patients in hospitals. They can occur when the catheter is inserted, during catheter use, and when the catheter is removed. Fortunately, these infections can be prevented to a large extent through behaviour change, thus reducing the need for antibiotics. Reducing the need for antibiotics is crucial in addressing antimicrobial resistance, which can lead to medicine becoming ineffective at fighting infections in the body.
Eleven interventions have been implemented nationally in England to decrease the prevalence of CAUTIs. Other interventions have been evaluated as part of a research study, but not implemented. In recent years, Public Health England has commissioned a number of studies to explore the extent to which CAUTI interventions address the underlying factors that are contributing to CAUTIs. These studies have been completed; however, the findings have not been presented in a policy-friendly format. Therefore, Public Health England and APRHAI (Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection) have requested a policy brief, summarizing the findings from these studies.
The policy brief will provide an overview of:
- CAUTI-related behaviour.
- Factors that contribute to CAUTI-related behaviours
- The extent to which interventions address the underlying factors that contribute to CAUTI-related behaviours
- The effectiveness of CAUTI interventions; and how interventions could be improved
Overall, this policy brief will facilitate the strategic identification of opportunities for intervention and policy refinement.