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Reporting and design elements of audit and feedback interventions: a secondary review
  1. Heather Colquhoun1,
  2. Susan Michie2,
  3. Anne Sales3,4,
  4. Noah Ivers5,
  5. J M Grimshaw6,7,
  6. Kelly Carroll6,
  7. Mathieu Chalifoux6,
  8. Kevin Eva8,
  9. Jamie Brehaut6,9
  1. 1Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Psychology and Language Sciences, University College London, London, UK
  3. 3Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
  4. 4Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  5. 5Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
  6. 6Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  7. 7Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  8. 8Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  9. 9Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Heather Colquhoun, Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, Canada M5G1V7; heather.colquhoun{at}


Background Audit and feedback (A&F) is a frequently used intervention aiming to support implementation of research evidence into clinical practice with positive, yet variable, effects. Our understanding of effective A&F has been limited by poor reporting and intervention heterogeneity. Our objective was to describe the extent of these issues.

Methods Using a secondary review of A&F interventions and a consensus-based process to identify modifiable A&F elements, we examined intervention descriptions in 140 trials of A&F to quantify reporting limitations and describe the interventions.

Results We identified 17 modifiable A&F intervention elements; 14 were examined to quantify reporting limitations and all 17 were used to describe the interventions. Clear reporting of the elements ranged from 56% to 97% with a median of 89%. There was considerable variation in A&F interventions with 51% for individual providers only, 92% targeting behaviour change and 79% targeting processes of care, 64% performed by the provider group and 81% reporting aggregate patient data.

Conclusions Our process identified 17 A&F design elements, demonstrated gaps in reporting and helped understand the degree of variation in A&F interventions.

  • Audit and feedback
  • Evidence-based medicine
  • Healthcare quality improvement
  • Implementation science

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  • Contributors All authors contributed to the conception and design of the study. HC, KC, MC and JB contributed to the acquisition, analysis and interpretation of data. HC, KC and JB drafted the manuscript. All author's contributed edits to, read and approved the final version of the manuscript.

  • Funding Canadian Institutes of Health Research (KTE 111-413).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.