A systematic review of electronic audit and feedback: intervention effectiveness and use of behaviour change theoryReportar como inadecuado




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Implementation Science

, 12:61

First Online: 12 May 2017Received: 03 December 2016Accepted: 28 April 2017DOI: 10.1186-s13012-017-0590-z

Cite this article as: Tuti, T., Nzinga, J., Njoroge, M. et al. Implementation Sci 2017 12: 61. doi:10.1186-s13012-017-0590-z

Abstract

BackgroundAudit and feedback is a common intervention for supporting clinical behaviour change. Increasingly, health data are available in electronic format. Yet, little is known regarding if and how electronic audit and feedback e-AandF improves quality of care in practice.

ObjectiveThe study aimed to assess the effectiveness of e-AandF interventions in a primary care and hospital context and to identify theoretical mechanisms of behaviour change underlying these interventions.

MethodsIn August 2016, we searched five electronic databases, including MEDLINE and EMBASE via Ovid, and the Cochrane Central Register of Controlled Trials for published randomised controlled trials. We included studies that evaluated e-AandF interventions, defined as a summary of clinical performance delivered through an interactive computer interface to healthcare providers. Data on feedback characteristics, underlying theoretical domains, effect size and risk of bias were extracted by two independent review authors, who determined the domains within the Theoretical Domains Framework TDF. We performed a meta-analysis of e-AandF effectiveness, and a narrative analysis of the nature and patterns of TDF domains and potential links with the intervention effect.

ResultsWe included seven studies comprising of 81,700 patients being cared for by 329 healthcare professionals-primary care facilities. Given the extremely high heterogeneity of the e-AandF interventions and five studies having a medium or high risk of bias, the average effect was deemed unreliable. Only two studies explicitly used theory to guide intervention design. The most frequent theoretical domains targeted by the e-AandF interventions included ‘knowledge’, ‘social influences’, ‘goals’ and ‘behaviour regulation‘, with each intervention targeting a combination of at least three. None of the interventions addressed the domains ‘social-professional role and identity’ or ‘emotion’. Analyses identified the number of different domains coded in control arm to have the biggest role in heterogeneity in e-AandF effect size.

ConclusionsGiven the high heterogeneity of identified studies, the effects of e-AandF were found to be highly variable. Additionally, e-AandF interventions tend to implicitly target only a fraction of known theoretical domains, even after omitting domains presumed not to be linked to e-AandF. Also, little evaluation of comparative effectiveness across trial arms was conducted. Future research should seek to further unpack the theoretical domains essential for effective e-AandF in order to better support strategic individual and team goals.

KeywordsTheory Behaviour and behaviour mechanisms Meta-analysis Medical audit Feedback Performance User-computer interface Electronic supplementary materialThe online version of this article doi:10.1186-s13012-017-0590-z contains supplementary material, which is available to authorized users.





Autor: Timothy Tuti - Jacinta Nzinga - Martin Njoroge - Benjamin Brown - Niels Peek - Mike English - Chris Paton - Sabine N van

Fuente: https://link.springer.com/







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