- Aims & Strategy
- Board & Key Stakeholders
- Contact Us
- Frequently asked questions
- HQIP Position Papers
- HQIP Interactive
- International links: Promoting clinical audit and QI overseas
- How we work: our people
- Job vacancies: work with HQIP
- Our accounts
- Stakeholder Survey 2010 results and how HQIP is responding
- The home of clinical audit
- Where we work
Literature on the effectiveness of clinical audit
There have been a number of reviews on the effectiveness of clinical audit, both within the UK and internationally. These are of variable quality and relevance. Some consider only the degree to which clinical audit leads to better compliance with published standards; others consider the degree to which health care outcomes improve as a result of clinical audit, as well as process compliance improvement.
- Comparative reports
- Digest of peer-reviewed clinical audit reports
- International reports (compliance)
- Other compliance reports
- Outcomes reports
Some comparative reviews of quality improvement methods include consideration of clinical audit against other methodologies, but many do not. A good example of one that does is:
International reports (compliance)
The main international study of the former type, despite its title is:
- Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD: Audit and feedback: effects on professional practice and health care outcomes : Cochrane Collaboration 2008.
- A follow up to this study has recently been published by the WHO Health Evidence Network (Flottorp et al, 2010): Using audit and feedback to health professionals to improve the quality and safety of health care.
Other reviews of the effectiveness of clinical audit at this level include:
- Hearnshaw H et al. Are audits wasting resources by measuring the wrong things? A survey of methods used to select audit review criteria. Qual Saf Health Care, 2003. 12, p 24-8
- Holdsworth J. Lessons from two decades of surgical audit . Clinical Governance: An International Journal. Vol 13, Number 2, 2008 , p115-127(13).
- Hoolden JD. Systematic review of published multi-practice audits from British general practice. J Eval Clin Pract 2004 May;10(2):p247-72.
- Grimshaw J et al. Systematic reviews of the effectiveness of quality improvement strategies and programmes. Qual Saf Health Care. 2003 August; 12(4): p 298-303.
- Foy R, et al. What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review. BMC Health Serv Res. 2005; 5: 50.
- Johnston G et al. Reviewing audit: barriers and facilitating factors for effective clinical audit. Qual Health Care 2000;9:p 23-36.
As to the effect on outcomes, a large number of studies which sought to assess whether audit can be shown to lead to improved outcomes were reviewed by Loughlan for HQIP in 2009. A summary of this can be found here.
A longer study, which uses the work by Loughlan as the beginning of a discussion on the challenges of evaluating the impact of quality improvement methods was published by HQIP in March 2011 and is available via this link.
A study by van de Veer et al (2010) reviews studies on the effect of registries, including projects which are or appear to be clinical audits, including on health outcomes as well as process improvements. This study identifies a number of studies where better outcomes have been achieved, but is clear that measurement alone without sustained feedback mechanisms is much more unlikely to bring benefits. (van de Veer S, De Keizer N, Ravelli A, Tenkink S and Jager K (2010) Improving quality of care. A systematic review on how medical registries provide information feedback to health care providers. IJMI 2010, 79. 305-323.
