Meta-analysis: audit and feedback features impact effectiveness on care quality.
Meta-analysis: audit and feedback features impact effectiveness on care quality.
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DOI：
10.1097/mlr.0b013e3181893f6b
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发表时间：
2009-03
期刊：
影响因子：
3
通讯作者：
Hysong SJ
中科院分区：
文献类型：
--
作者：
Hysong SJ
审计和反馈（A&F）长期以来一直被用于提高护理质量，尽管结果不一。本meta分析研究检验了反馈干预理论（一个来自工业/组织心理学的框架）是否解释了卫生保健A&F研究中观察到的变动性。Jamtvedt在2006年Cochrane对A&F的系统综述中引用的研究，随后使用Cochrane综述的搜索策略进行数据库搜索，以确定更多的最新研究。Cochrane评价标准，加上：存在只接受A&F治疗的治疗组；对照组不接受干预；可量化的结果；每只手臂最少10只；足够的统计数据进行效应量计算。气馁和赞美的存在；正确的解决方案、达到的水平、速度、频率和规范信息；反馈形式（口头、文本、图形、公开、计算机化、团体与个人）；目标设定活动。采用赫奇斯-奥尔金方法的元分析程序。在最初确定的519项研究中，有19项符合所有纳入标准。由于缺乏仅反馈的组，研究通常被排除在外。A&F对质量结果有适度但显著的积极影响（d= 0.40, 95% CI±0.20）；提供具体的改进建议，书面和更频繁的反馈加强了这种效果，而图形和口头反馈则减弱了这种效果。当以书面形式频繁地提供带有具体改进建议的反馈时，A&F的有效性就会得到提高。其他反馈特征也可能潜在地提高有效性；然而，需要更严格的实验控制研究来确定最大化其有效性的特定反馈特性。
Audit and feedback (A&F) has long been used to improve quality of care, albeit with variable results. This meta-analytic study tested whether Feedback Intervention Theory, a framework from industrial/organizational psychology, explains the observed variability in health care A&F research. Studies cited by Jamtvedt's 2006 Cochrane systematic review of A&F, followed by database searches using the Cochrane review's search strategy to identify more recent studies. Cochrane review criteria, plus: presence of a treatment group receiving only A&F; a control group receiving no intervention; a quantitatively measurable outcome; minimum n of 10 per arm; sufficient statistics for effect size calculations. Presence of discouragement and praise; correct solution, attainment level, velocity, frequency, and normative information; feedback format (verbal, textual, graphic, public, computerized, group vs. individual); goal setting activity. Meta-analytic procedures using the Hedges-Olkin method. Of 519 studies initially identified, 19 met all inclusion criteria. Studies were most often excluded due to the lack of a feedback-only arm. A&F has a modest, though significant positive effect on quality outcomes (d=.40, 95% CI ±.20); providing specific suggestions for improvement, written, and more frequent feedback strengthened this effect, whereas graphical and verbal feedback attenuated this effect. A&F effectiveness is improved when feedback is delivered with specific suggestions for improvement, in writing, and frequently. Other feedback characteristics could also potentially improve effectiveness; however, research with stricter experimental controls is needed to identify the specific feedback characteristics that maximize its effectiveness.