What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review

We selected an important chronic disease encountered in primary care: diabetes mellitus. We identified recommendations from National Institute for Clinical Excellence (NICE) guidance on conducting audit and generated questions which would be relevant to any attempt to operationalise audit and feedback in a healthcare service setting. We explored the extent to which a systematic review of audit and feedback could provide practical guidance about whether audit and feedback should be used to improve quality of diabetes care and, if so, how audit and feedback could be optimised.National guidance suggests the importance of securing the right organisational conditions and processes. Review evidence suggests that audit and feedback can be effective in changing healthcare professional practice. However, the available evidence says relatively little about the detail of how to use audit and feedback most efficiently.Audit and feedback will continue to be an unreliable approach to quality improvement until we learn how and when it works best. Conceptualising audit and feedback within a theoretical framework offers a way forward.A range of strategies exist to promote the uptake of clinical research findings into the routine care of patients. They seek to change the behaviour of healthcare professionals and thereby improve the quality of patient care (Table 1). For each of these strategies a number of trials of their effectiveness have been drawn together within systematic reviews.[1,2] By examining interventions in a range of settings and circumstances such reviews aim to produce generalisable messages about the effectiveness or otherwise of these interventions.All healthcare systems are concerned with improving the quality of care that they deliver as demonstrated by their establishment of structures (such as the UK NHS National Institute for Clinical Excellence (NICE], the Australian National Institute for Clinical Studies) and high profile reports.[3] Across countries clinic