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The Audit & Feedback MetaLab

Creating shared learning and expertise on Audit & Feedback

Audit & feedback (A&F)
is defined as a summary of clinical performance provided over a specified period of time, and aims to improve healthcare quality.

The A&F MetaLab website allows those using A&F and researchers in the field to connect and create shared learning across A&F laboratories around the world to increase the effectiveness of A&F.

Learn more about the A&F MetaLab and what we aim to achieve in our BMJ Quality and Safety article here.



What the A&F MetaLab offers

This website is for those involved in measuring quality indicators and feeding them back to healthcare professionals including:


Policy Makers


Healthcare Providers


Intervention Designers


Researchers

We offer a list of resources to help you design and evaluate A&F interventions and explain the theory and evidence behind the success or failure of A&F.

A group of researchers dedicated to improving healthcare outcomes by optimizing performance with Audit & Feedback (A&F) The members of the A&F MetaLab are internationally recognized leaders in the field of audit and feedback.

They have committed their expertise to developing the A&F MetaLab and promoting the use and development of audit and feedback to improve healthcare delivery and health overall.

The mission of the A&F MetaLab is to develop an international research and healthcare community to achieve the following:

  • Encourage shared learning from international A&F implementation laboratories
  • Engage with healthcare system partners regarding their use of A&F
  • Provide a trusted source of evidence and recommendations for performing A&F
  • Develop a repository of international A&F lab members and their expertise
  • Encourage the promotion and uptake of A&F evidence
  • Synthesise evidence from the A&F implementation lab activities
  • Training for building research capacity and practical expertise in A&F
  • Develop an ongoing repository of evidence from randomised tests of refinements to A&F in the various national implementation labs

What is Audit & Feedback?

Audit & Feedback (A&F) is any summary of clinical performance of healthcare provided over a specified period of time.

This summary may be given in a written, electronic or verbal format ( Jamtvedt et al. 2006 ) and may include recommendations for clinical action ( Ivers et al. 2014 ).

The summary data may have been obtained from medical records, computerized databases, or observations from patients.

How does Audit & Feedback work?

A&F provides objective data regarding discrepancies between current clinical practices and target performance, as well as comparisons of performance to other health professionals (Ivers et al. 2014).

It is thought that demonstrating this gap between actual and desired performance can act as a cue for action and will motivate clinicians or healthcare systems to change their behaviour and address the gap (Ivers et al. 2014; Foy & Eccles 2013).

  • This explanation however does not address what the specific mechanisms of action are!

The effectiveness of A&F may be influenced by:

  • the characteristics of the targeted behavior
  • the recipients
  • their context
  • the components of the A&F intervention itself(Ivers et al. 2014)

The most recent update of the Cochrane Systematic Review (Ivers et al. 2012):

  • Included 140 randomized trials of A&F conducted across many clinical conditions and settings around the world
  • Found that A&F leads to a median 4% absolute improvement (IQR 0.5% to 16%) in provider compliance with desired practice
  • However, the review could not provide answers on mechanisms of action

Audit & Feedback Laboratories can help work towards these missing answers!

There are many different theories from different disciplines that can be applied to healthcare; some theories are exclusively about feedback whereas some include feedback as a component. Different theories discuss feedback in different context. However, only few studies explicitly used theory to design their A&F intervention and none of them used theory specific to A&F (see Table below).
To increase the consistency and magnitude by which A&F interventions achieve change we need to design interventions informed by extant theory and empirical evidence. Using theory can help to define and clarify potential mechanisms of action helping to create more effective interventions (Colquhoun et al. 2013).
Examples of theories specific to A&F are Control Theory, Goal Setting Theory, Feedback Intervention Theory and the newly developed Clinical Performance Feedback Intervention Theory (CP-FIT).
  • Control Theory suggests that people will develop action plans to achieve behaviour change when observing a discrepancy between current practice and target behaviour.
  • According to Goal Setting Theory people are motivated to achieve a goal rather than eliminate the discrepancy.
  • Feedback Intervention Theory builds upon these two theories and suggests that feedback that directs attention towards acceptable and familiar tasks (as opposed to those that generate emotional responses or cause deep self-reflection) seem most likely to lead to improvement.
  • Clinical Performance Feedback Intervention Theory (CP-FIT) builds upon 30 pre-existing theories and states that effective feedback works in a cycle of sequential processes. Feedback’s success is influenced by several factors: the feedback method used, health professional receiving feedback, and context in which feedback takes place.
Clinical Performance Feedback Intervention Theory’s variables and explanatory mechanisms, and their influence on the feedback cycle. Solid arrows are necessary pathways for successful feedback. Dotted arrows represent potential pathways.
Clinical Performance Feedback Intervention Theory’s variables and explanatory mechanisms, and their influence on the feedback cycle. Solid arrows are necessary pathways for successful feedback. Dotted arrows represent potential pathways.
Various recent A&F studies now use these theories in their design such as Gude et al. and Hartley et al.
The theories are also used to evaluate A&F such as Hysong et al. and Gardner et al.
The Table below provides a list of all of the theories identified from the 2012 Cochrane update on audit and feedback interventions. This table has been adapted from Table 1 in Colquhoun et al. 2013
TYPE THEORY AUTHOR YEAR
Education Adult Learning Theory Knowles 1984, 1990
Theory of Medical Education Coles & Holm 1993
Diffusion Diffusion of Innovations Rogers 1983, 1995
Technology Diffusion Theory Penland 1997
Organization Diffusion of Innovations in Service Organizations Greenhalgh, Robert, Macfarlane, Bate & Kyriakidou 2004
Lawler’s Organization Theory Lawler 1976
Organization Development Theory Levitt 1965
Kirkpatrick’s Hierarchy of Levels of Evaluation Kirkpatrick 1967
Psychology Social Cognitive Theory Bandura 1969, 1986, 1997
Transtheoretical Model Prochaska & DiClemente 1982, 1986, 1992
Theory of Reasoned Action Fishbein, Fishbein & Ajzen 1979, 1968
Theory of Planned Behaviour Ajzen 1991
Social Cognitive Models Conner & Norman 1996
Precede/Proceed Planning Model Green & Kreeuter 1991
Human Error Theory Reason 2000
Behavioural Psychology Theory Ullman & Krasner 1975
Social Learning Theory Perry, Baranowski, & Parcel 1990
Audit & Feedback Specific Control Theory Carver & Scheier 1982
Goal Setting Theory Locke & Latham 2002
Feedback Intervention Theory Kluger & Denisi 1996

Below are recommendations to take into consideration when both designing and reporting audit & feedback.

Designing Audit & Feedback

From ‘Knowledge Translation in Health Care (Foy & Eccles 2013):

  • Type of format, i.e. verbal, paper or electronic;
  • Frequency and duration, e.g. as a one-off step or continuously and often over a period of time
  • Source, e.g. whether from a supervisor or professional body
  • Content, e.g. information on healthcare processes or patient outcomes, use of identifiers to permit comparisons between individual professionals, teams or facilities
  • Use of various sources to deliver feedback, such as supervisors or professional bodies
  • Context

From the Cochrane Systematic Review (Ivers et al. 2012):

  • Source is a supervisor or colleague
  • Is delivered more than once
  • Is verbal and written
  • Aims to decrease undesirable behavior as opposed to increase desirable behavior
  • Includes explicit targets and action plan

From the SOCIAL Systematic Review  (Tang et al. 2021):

This systematic review provides strong evidence from many studies to suggest the following implications for policy and practice:

  • Social norms interventions1 targeting health workers are effective in both changing the clinical behaviour of health workers and improving outcomes for patients, and should continue to be implemented (102 studies).
  • Credible source (where the target health worker understands that a clinical behaviour has the approval of someone they regard as a credible source) is, on average, effective and should continue to be implemented. It is effective both on its own and as part of a complex intervention (15 studies).
  • Social comparison, where a target health worker is provided with information about the clinical behaviour of their peers, allowing them to make a comparison with their own behaviour, is, on average, effective and should continue to be implemented. It is effective both on its own and as part of a complex intervention, and is more effective than simply providing feedback on the target’s behaviour (81 studies). Social comparison can be enhanced by the use of prompts/cues, such as providing lists of patients to support decision-making (such as those who have test results that warrant investigation), or computerised pop-ups when particular codes are entered into an electronic system). The benefit of prompts and cues may not apply when the behaviour is not well understood by the health worker or they need to learn new skills to undertake it (10 studies).

Social norms interventions can be used to good effect across a wide range of health contexts:

  • They are effective in changing the behaviour of doctors (68 studies) and other health workers (12 studies).
  • They can be used successfully to change a variety of behaviours, such as prescribing (40 studies), ordering and conducting tests (21 studies), managing long-term conditions and improving communication with patients (23 studies).
  • They are suitable for use in both increasing behaviour (e.g. more frequent contact with patients or increase in blood testing for a particular condition) (70 studies) or reducing behaviour (e.g. fewer prescriptions for antibiotics or reduction in the number of unwarranted blood tests) (28 studies).
  • They can be used successfully in both primary (56 studies) and hospital care (27 studies).

Mode of delivery:

  • The source of the intervention can be internal or external.
  • Formats including e-mail (9 studies), written (25 studies), web based (8 studies) and mixed (14 studies) have all been used successfully.

1A social norms intervention seeks to change the clinical behaviour of a target health worker by exposing them to the values, beliefs, attitudes or behaviours of a reference group or person. These social norms interventions can form part of an audit and feedback (A&F) initiative, or may be developed as another behaviour change intervention. These are often interventions with reach: they can be implemented across multiple health workers and settings at low cost, so there is the potential for large absolute gain.

References:

  • Tang, M.Y., Rhodes, S., Powell, R. et al. How effective are social norms interventions in changing the clinical behaviours of healthcare workers? A systematic review and meta-analysis. Implementation Science 16, 8 (2021). https://doi.org/10.1186/s13012-020-01072-1
  • Cotterill S, Tang MY, Powell R, Howarth E, McGowan L, Roberts J, Brown B, Rhodes S. Social norms interventions to change clinical behaviour in health workers: a systematic review and meta-analysis. Health Services Delivery Res 2020;8(41) https://doi.org/10.3310/hsdr08410

See also ‘Practice Feedback Interventions: 15 Suggestions for Optimizing Effectiveness (Brehaut et al. 2016)

Reporting Audit & Feedback

From “Reporting and design elements of audit and feedback interventions: a secondary review’ (Colquhoun et al 2016):

Colquhoun et al. suggest that at a minimum, A&F intervention designers should report and justify the following.

  • Who the A&F will be delivered to
  • What information will be delivered
  • When the information will be delivered (in relation to collection of the data)
  • Why the information is being delivered
  • When the information will be delivered
  • How many times is the information delivered

The authors recommend considering all 17 items below when designing an intervention and reporting these items whenever possible

Category Item
Who 1. Was the feedback given to an individual, a group or both
2. Was it given to the person in whom the practice change was desired (eg. healthcare provider vs hospital administrator)
What 3. Was there feedback about the processes of care (eg. rate of antibiotic prescription)
4. Was there feedback about patient outcomes
5. Was there feedback about something other than processes of care or patient outcomes (if yes, specified)
6. Was the feedback about individual provider performance
7. Was the feedback about the performance of the provider group
8. Was the feedback about individual patient cases
9. Was the feedback about an aggregate of patient cases
10. Did the feedback identify a specific behaviour(s) to be changed
11. What was the comparison provided in the feedback (specified)
12. Were graphical elements included in the feedback
When 13. What was the lag between the time of the audit and the delivery of the feedback (days, weeks, months, years, a mix)
14. What rationale was given for using A&F (specified)
How 15. Was the feedback given face to face
16. Were providers explicitly asked to consider the implications the A&F has for their practice
How much 17. What was the total number of times the feedback was given (specified)

We’re in the process of updating this section with the latest details. Stay tuned for new content soon!

Electronic Audit & Feedback

Electronic audit and feedback intervention with action implementation toolbox to improve pain management in intensive care: protocol for a laboratory experiment and cluster randomised trial

The NICE dashboard: detailed insight in clinical performance on quality indicators
Gude et al. 2017. Impl Sci 12:68

A mixed methods evaluation of the maternal-newborn dashboard in Ontario: dashboard attributes, contextual factors, and facilitators and barriers to use: a study protocol

Dunn-AF
Dunn et al. 2016. Impl Sci. 11:59.

Interface design recommendations for computerised clinical audit and feedback: Hybrid usability evidence from a research-led system

BORN maternal-newborn dashboard sample home page
Brown et al. 2016. Int J Med Inform. 94:191-206

Systematic Reviews

(Lists of studies using Audit & Feedback)

General A&F (see “References to studies included in this review”)

A&F: Effects on professional practice and healthcare outcomes

Electronic A&F

A systematic review of electronic audit and feedback

Dashboards

International Journal of Medical Informatics

We’re in the process of updating this section with the latest details. Stay tuned for new content soon!

We’re in the process of updating this section with the latest details. Stay tuned for new content soon!

What is an Audit & Feedback Laboratory?

An Implementation Laboratory is a research team integrated into healthcare systems undertaking program(s) of research directly relevant to healthcare systems’ priorities (Ivers & Grimshaw 2016)

  • We are looking at audit & feedback, so are referring to these as Audit & Feedback (A&F) Laboratories

How can Audit & Feedback Laboratories Help?

A&F Laboratories are helpful because they (Ivers & Grimshaw 2016):

  • Reduce problems relating to convening de novo research teams, seeking project by project funding, negotiating access with healthcare systems, conducting study, writing up results (usually out of funding period)
  • Provide opportunities for formal and informal linkages of mutual advantage to the research team and healthcare system
  • Allow teams to test comparative effectiveness of implementation interventions at scale
  • Testing intervention design, and delivery will allow for future optimization

Testing comparative effectiveness of different ways of delivering audit and feedback needs large sample sizes that are unlikely to be realized in one-off research projects

  • Collaborating with health system partners can help address this problem

Delivering large scale audit and feedback programs within healthcare systems benefits all participants

  • Benefits for health system-learning organization, demonstrable improvements in its quality improvement activities, linkages to academic experts
  • Benefits for implementation science – ability to test important (but potentially subtle) variations in audit and feedback that may be important effect modifiers
  • I.e. What works better in A&F, and why?

Audit & Feedback Laboratories

Audit and feedback interventions to increase the uptake of evidence-based transfusion practice

Objective:

The AFFINITIE project aims to design and evaluate enhanced feedback interventions, within a national blood transfusion audit programme, to promote the uptake of evidence-based guidance and reduce the unnecessary use of blood components.

Project Link:

https://medhealth.leeds.ac.uk/info/555/research/1388/affinitie_programme

Publications:

https://www.ncbi.nlm.nih.gov/pubmed/25070404

https://www.ncbi.nlm.nih.gov/pubmed/27955683

https://www.ncbi.nlm.nih.gov/pubmed/28673310

Funded By:

National Institute for Health Research (NIHR)

Partner Links:

NHS Blood & Transplant – http://www.nhsbt.nhs.uk/

BORN Maternal Newborn Dashboard

Objective:

To help institutions and care providers learn about their own performance, the Better Outcomes Registry & Network (BORN) Ontario has implemented an audit and feedback system, the Maternal-Newborn Dashboard (MND), for all hospitals providing maternal-newborn care.

Project Link:

http://www.bornontario.ca/en/born-information-system/report-training/

Funded By:

Ontario Ministry of Health and Long-Term Care, Canadian Institutes of Health Research

Partner Links:

Study Summary:

  • Population – Health care providers providing maternal newborn care
  • Intervention – Electronic online audit and feedback system
  • Comparator – Peer comparators (level of care hospitals, volume of birth hospitals, and Ontario rates)
  • Outcome – Rate improvement for each KPI with ultimate goal to reach target benchmark set
  • Setting – Hospitals in Ontario providing maternal newborn care

Publications:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855363/

https://qualitysafety.bmj.com/content/qhc/27/6/425.full.pdf

https://qualitysafety.bmj.com/content/qhc/early/2019/02/16/bmjqs-2018-008354.full.pdf

Study Contact:

Sandra Dunn RN, PhD
Knowledge Translation Specialist, BORN Ontario
CHEO Research Institute – CPCR Building
401 Smyth Road | Ottawa, ON | K1H 8L1
T: 613.737.7600 x6018
sdunn@BORNOntario.ca

Olivia Daub, MSc, MClSc, PhD
Knowledge Translation Specialist, BORN Ontario
odaub@bornontario.ca

Healthcare/audit partner:

Corilus (Electronic Health Record Vendor)

Research Partners:

Academic Center for General Practice, KU Leuven 

context:

Intego is a Flemish (Belgian) primary care morbidity registry that automatically collects EHR data from more than >450 General practitioners on a weekly basis. Intego has built a database that contains about 14 million diagnoses, >150 million laboratory results and 30 million prescriptions for medication.

Aim of Audit:

To pilot different A&F interventions that are built into the EHR of the GP and to use the Intego database as a testing ground / implementation laboratory.

Scope and scale of audit:

After pilot testing, evaluating and improving the automated A&F interventions in the practices of the Intego network, the interventions could be scaled up to national (Belgian) level.

Aim of research:

To automate (built-in) A&F interventions in the EHR of the GP and to investigate different features of feedback.

Audit & Feedback interventions being tested:

  • An automated A&F intervention to improve the quality of diabetes primary care (work in progress)
  • An automated A&F intervention to improve antibiotic stewardship in primary care (work in progress)

Evaluation design:

Different cluster RCT designs will be explored to evaluate different features of automated A&F.

oversight:

Intego

For more information: Steve Van den Bulck steve.vandenbulck@kuleuven.be

Ethical approval:

The INTEGO procedures were approved by the KU Leuven Ethics Committee (nr. ML1723) and by the Belgian National Privacy Commission’s Sectoral Committee (decision nr. 13.026 of March 19, 2013, last modified on April 17, 2018).

Audit Funding:

Agency Care & Health (Agentschap Zorg & Gezondheid), Flemish Government

Ebpracticenet

Research Funding:

Agency Care & Health (Agentschap Zorg & Gezondheid), Flemish Government

Creating shared learning and expertise on Audit & Feedback

Ontario Health Implementation Laboratory

Objective:

The Ontario Health Implementation Laboratory (OHIL) working in partnership with provincial organizations, including Health Quality Ontario (HQO), Public Health Ontario (PHO) and Cancer Care Ontario (CCO),  aims to evaluate system-wide quality improvement activities such as audit and feedback. OHIL seeks to maximize the impact of existing partner initiatives, and advance implementation research, while emphasizing patient engagement, knowledge translation and exchange, as well as capacity building.

Project Link:

http://webapps.cihr-irsc.gc.ca/decisions/p/project_details.html?applId=379247&lang=en

http://ossu.ca/research/impact-awards2/improving-ontarios-health-care-system/

Publications:

No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention

OHIL currently features two streams of work focusing on the following topics:

  • Improving Antibiotic Prescribing
  • Improving Opioid Prescribing
  • Details on past streams of work can be found below.

Improving Antibiotic Prescribing: Antibiotics are prescribed more often than necessary, leading to avoidable short-term harms for patients as well as contributing to antimicrobial resistance at both the patient and population-level. We will carry out a series of trials testing the design of an audit and feedback (A&F) report provided to primary care (PC) physicians working in the province of Ontario in order to identify the most effective A&F for reducing inappropriate antibiotic prescribing.

Primary Care, Pragmatic Cluster Trials and Process Evaluations

  • Project Link: n/a
  • Funded By: Canadian Institutes of Health Research (CIHR)
  • Partner Links: Health Quality Ontario; Public Health Ontario
  • Study Summary:
    • Population – PC physicians in Ontario receiving Health Quality Ontario (HQO) feedback reports
    • Intervention – Testing the design of feedback in the form of HQO feedback reports
    • Comparator – Standard versus an ‘enhanced’ (e.g., personalized message and action plan) feedback report
    • Outcome – Metrics presented within feedback reports (e.g., the number of antibiotic prescriptions dispensed)
    • Setting – PC in Ontario
  • Publications: n/a
  • Study Contact:

Michelle Simeoni
Research Coordinator, WCRI
Women’s College Hospital
Phone: 416-323-6400 ext. 5368

Improving Opioid Prescribing: With the heightened awareness of risks associated with opioids, increasing attention is focused on safely managing patients with chronic non-cancer pain who are taking opioids, especially those taking high doses. We will evaluate two large-scale interventions that aim to encourage safer opioid prescribing practices in primary care (PC).

Observational Trial and Process Evaluation

  • Project Link: n/a
  • Funded By: Canadian Institutes of Health Research (CIHR)
  • Partner Links: The Centre for Effective Practice; Health Quality Ontario
  • Study Summary:
    • Population – PC physicians in Ontario receiving Health Quality Ontario (HQO) feedback reports and/or academic detailing services from the Centre for Effective Practice
    • Intervention – Two voluntary opioid-related supports – feedback reports and/or academic detailing services delivered by a trained detailer
    • Comparator – Receipt of feedback reports and/or academic detailing services
    • Outcome – Metrics presented within the feedback reports and/or covered during the detailing service (e.g., high risk opioid prescriptions in PC patients)
    • Setting – PC in Ontario
  • Publications: n/a
  • Study Contact:

Catherine Reis
Research Coordinator, WIHV
Women’s College Hospital
catherine.reis@wchospital.ca

PAST STREAMS OF WORK

Audit & Feedback (A&F): Health Quality Ontario (HQO) provides ‘practice reports’ to all physicians working in nursing homes (MyPractice Long Term Care Reports) and working in primary care (MyPractice Primary Care Reports). These reports provide ‘feedback’ regarding performance on key quality indicators based on an ‘audit’ of relevant administrative databases. OHIL works with HQO in a variety of ways to optimize the impact of these Practice Reports.

A) Long-Term Care Factorial Trial, Baseline Time Series and Process Evaluation

Catherine Reis
Research Coordinator, WIHV
Women’s College Hospital
catherine.reis@wchospital.ca

B) MyPractice Primary Care Reports Redesign and Patient Engagement to Prioritize Quality Indicators

  • Project Link: None
  • Funded By: Ontario SPOR Support Unit (OSSU)
  • Partner Links: Health Quality Ontario
  • Study Summary:
    • Approaches to prioritizing quality indicators to feature in the feedback reports provided to primary care (PC) physicians; and
    • How a user-centered design process could inform the format and presentation of PC feedback reports
  • Publications:
    • Engaging Patients to Select Measures for a Provincial Primary Care Audit and Feedback Initiative (in progress)
    • Redesigning Feedback Reports for Use in Primary Care: Evaluating a User-Centered Design Approach (in progress)
  • Study Contact:

Catherine Reis
Research Coordinator, WIHV
Women’s College Hospital
catherine.reis@wchospital.ca

Quality Based Procedures (QBPs): Quality Based Procedures are a component of Ontario’s Health System Funding Reform. As defined by the Ministry of Health (2016), QBPs are “specific groups of patient services that offer opportunities for health care providers to share best practices that will allow the system to achieve even better quality and system efficiencies.” QBPs are similar in some, but not all, respects to international attempts to encourage standardization of care and improve efficiency through patient-based (also known as activity-based) funding reforms.

Karen Palmer
karen.palmer@wchospital.ca

National Intensive Care Evaluation foundation (NICE) electronic quality dashboard with action implementation toolbox to enhance quality of pain management in Dutch intensive care units

OBJECTIVE:

To investigate ICU professionals’ perceptions about their clinical performance and the influence of A&F on their intentions to change practice; and to assess the effects of an electronic A&F intervention with action implementation toolbox compared to the intervention without toolbox.

PROJECT LINK:

https://stichting-nice.nl/

PUBLICATIONS:

 Study Protocol: https://www.ncbi.nlm.nih.gov/pubmed/28545535

Results: https://www.ncbi.nlm.nih.gov/pubmed/29454393

FUNDED BY:

NICE foundation and Dutch association of Medical Specialists

STUDY INFORMATION:

Healthcare / audit partner. Dutch National Intensive Care Evaluation (NICE) quality registry.

Research partners. Academic Medical Center, University of Amsterdam, NL. Health e-Research Centre, University of Manchester, UK.

Context. During their patients’ stay at an intensive care units (ICU) they are exposed to adverse experiences; acute pain being a leading stressor. Physical and psychological stress caused by pain have been shown to be associated with increased length of stay, morbidity and poor mental health outcomes, and affect quality of life even after ICU discharge. There remains a large gap between ideal and actual care with respect to pain management in intensive care.

Aim of audit. To improve clinical performance on recently developed quality indicators relating to pain management in Dutch ICUs.

Scope and scale of audit. All (n=83) Dutch intensive care units.

Aim of research. To investigate ICU professionals’ perceptions about their clinical performance and the influence of A&F on their intentions to change practice; and to assess the effects of an electronic A&F intervention with action implementation toolbox compared to the intervention without toolbox.

A&F interventions being tested. An online quality dashboard that allows users to gain insight into clinical performance and develop action plans. The intervention group additionally receives access to an integrated action implementation toolbox of suggested actions and materials to further support the development and management of action plans.

Evaluation design. First is a laboratory experiment with 72 individual professionals from 21 ICUs to assess the impact of feedback on their intentions to improve practice. Second is a two-arm cluster randomised controlled trial with the same 21 ICUs allocated to feedback without or feedback with action implementation toolbox group. Both arms receive telephone support to increase engagement. In the near future the dashboard is extended with other clinical domains: antibiotics use, mechanical ventilation and blood transfusions.

Oversight. Board of directors at the NICE foundation.

Ethical approval. The Institutional Review Board (IRB) of the Academic Medical Center (Amsterdam, The Netherlands) stated that formal IRB approval and patient consent was not deemed necessary because to the focus of intervention on improving organisational processes; individual patients will not be directly involved (IRB reference number: W16_271)

Audit funding. NICE foundation

Research funding. NICE foundation and Dutch association of Medical Specialists

Trial registration. ClinicalTrials.gov with reference NCT02922101.

STUDY CONTACT:

Professor N.F. de Keizer
n.f.keizer@amc.uva.nl

Translation Research in a Dental Setting

Objective:

The TRiaDS programme aims to develop and evaluate the implementation of strategies to improve the knowledge-to-practice gap in primary care dentistry in Scotland.

Project Link:

http://www.triads.org.uk/

Funded By:

NHS Education for Scotland

Implementing goals of care conversations with veterans in VA long term care settings

OBJECTIVE:

To support implementation of the  Life Sustaining Treatment Decision Initiative (LSTDI) in long term care settings throughout Veterans Health Administration in VISN 4 (Pennsylvania), VISN 10 (Michigan and Indiana), and VISN 19 (Colorado, Utah, Wyoming, Montana and Oklahoma).

PUBLICATIONS:

FUNDED BY:

VA QUERI Program (QUE 15-288)

STUDY INFORMATION:

Healthcare / audit partner. Data are electronically stored in VA Corporate Data Warehouse; operational partner is VA National Center for Ethics in Health Care.

Research partners. CCMR, VA Ann Arbor Healthcare System; Philadelphia VA Medical Center; Denver VA Medical Center.

Context. A new VA Handbook, the Life Sustaining Treatment Decision Initiative (LSTDI), has been disseminated to VHA facilities requiring documentation of goals of care conversations using a detailed standardized template in the VA EMR for recording these conversations. This initiative applies to seriously ill Veterans in all VHA settings. Our project focuses on implementing this Handbook and the related template in long term care settings (VA owned nursing homes and home based primary care).

Aim of audit. Data are electronically extracted from existing national databases for the purpose of understanding proportion of long term care patients who have had a goals of care conversation documented in the standardized template.

Scope and scale of audit. All Veterans in Community Living Centers (VA owned nursing homes) and Home Based Primary Care throughout the Veterans Health Administration in the United States.

Aim of research. To support implementation of the LSTDI in long term care settings throughout VHA in VISN 4 (Pennsylvania), VISN 10 (Michigan and Indiana), and VISN 19 (Colorado, Utah, Wyoming, Montana and Oklahoma).

A&F interventions being tested. Electronically generated feedback reports providing feedback on performance in documenting goals of care conversations, coupled with learning collaboratives. Different formats and delivery of feedback reports will be tested.

Evaluation design. Quasi-experimental mixed methods design using interrupted time series.

Oversight. Steering Committee comprised of three VA operational partners: Geriatrics and Extended Care Service; National Center for Ethics in Health Care; and the Office of Nursing Services.

Ethical approval. Exempted from review as quality improvement by VA Ann Arbor Healthcare System Research and Development Committee.

Audit funding. N/A.

Research funding. VA QUERI Program (QUE 15-288).

Trial registration. N/A.

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Call for Abstracts – Now Open!

Submit Your Abstract

We are now accepting abstracts for the 10th International Audit & Feedback in Healthcare Conference: Celebrating a Decade of Progress & Shaping the Future, taking place online (regional gatherings will be planned – details TBA), on November 6-7, 2025.

Please join us and share with our supportive and thoughtful international community what you are currently working on, or have recently completed. While we welcome all submissions related to A&F in healthcare, we are particularly interested in presentations that fit within the following themes:

  • Using A&F Implementation Science Laboratories to advance the field
  • Advancing methods for A&F
  • Novel uses for A&F or novel evidence for A&F effectiveness

Presentation Formats

Accepted abstracts will be assigned to one of the following formats:

  • 10–15-minute oral presentation (including Q&A)
  • Poster presentation with 3-minute elevator pitch (video)
  • 45-minute oral presentation (including Q&A; limited availability)
  • Interactive workshop (60–90 minutes; limited availability)

Abstract Submission Guidelines

  • Abstracts must be submitted using the online submission form (linked below).
  • Abstracts should be a maximum of 3,500 characters, excluding the title and author list.
  • You may use structured headings such as: Background, Objectives, Methods, Results, Discussion.
  • Do not include the title or author list in the abstract text; these will be entered separately.
  • Please indicate your preferred presentation format and theme. The Scientific Committee will consider these preferences, but reserves the right to assign accepted abstracts to the most appropriate stream based on fit, balance, and availability.

Key Dates

  • Submission Deadline: May 31, 2025, 11:59 PM EST
  • Notification of Acceptance: July 2025

Submit Your Abstract

Questions? Contact Natasha at AFMetaLab@wchospital.ca.

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Have Questions or Need More Information? We’re here to help! For general inquiries about our work, events, or initiatives, please reach out to us at AFMetaLab@wchospital.ca. We look forward to connecting with you!