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A systematic review of electronic audit and feedback: intervention effectiveness and use of behaviour change theory

机译：电子审核和反馈的系统评价：干预效果和行为改变理论的使用

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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-A&F) improves quality of care in practice. ObjectiveThe study aimed to assess the effectiveness of e-A&F 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-A&F 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-A&F 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-A&F 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-A&F 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-A&F effect size. ConclusionsGiven the high heterogeneity of identified studies, the effects of e-A&F were found to be highly variable. Additionally, e-A&F interventions tend to implicitly target only a fraction of known theoretical domains, even after omitting domains presumed not to be linked to e-A&F. 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-A&F in order to better support strategic individual and team goals.
机译：背景审计和反馈是支持临床行为改变的常见干预措施。健康数据越来越以电子格式提供。然而，关于电子审计和反馈（e-A＆F）是否以及如何提高实践中的护理质量，人们知之甚少。目的这项研究旨在评估在初级保健和医院环境中进行e-A＆F干预的有效性，并确定这些干预背后行为改变的理论机制。方法2016年8月，我们通过Ovid搜索了MEDLINE和EMBASE等五个电子数据库，并通过Cochrane对照试验中央注册系统对已发表的随机对照试验进行了研究。我们纳入了评估e-A＆F干预措施的研究，定义为通过交互式计算机界面向医疗保健提供者提供的临床表现的摘要。两位独立的评论作者提取了有关反馈特征，基本理论领域，影响范围和偏见风险的数据，他们确定了理论领域框架（TDF）中的领域。我们对e-A＆F的有效性进行了荟萃分析，并对TDF域的性质和模式以及与干预效果的潜在联系进行了叙述性分析。结果我们纳入了7项研究，由329位医疗保健专业人员/初级保健机构所护理的81,700名患者组成。鉴于e-A＆F干预措施的异质性极高，并且有5项研究具有偏高或中等偏见风险，因此平均效果被认为是不可靠的。只有两项研究明确使用理论指导干预设计。 e-A＆F干预所针对的最频繁的理论领域包括“知识”，“社会影响力”，“目标”和“行为监管”，每种干预至少针对三种。这些干预措施均未涉及“社交/专业角色和身份”或“情感”领域。分析发现，在控制臂中编码的不同域的数量在e-A＆F效应大小的异质性中具有最大作用。结论鉴于已鉴定研究的高度异质性，发现e-A＆F的影响差异很大。此外，即使省略假定不与e-A＆F关联的领域，e-A＆F干预措施也往往只隐含地瞄准了一部分已知理论领域。此外，几乎没有对各试验部门的相对有效性进行评估。未来的研究应寻求进一步剖析有效的A＆F必不可少的理论领域，以便更好地支持个人和团队的战略目标。

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