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

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          Abstract

          Background

          Audit and feedback interventions in healthcare have been found to be effective, but there has been little progress with respect to understanding their mechanisms of action or identifying their key ‘active ingredients.’

          Discussion

          Given the increasing use of audit and feedback to improve quality of care, it is imperative to focus further research on understanding how and when it works best. In this paper, we argue that continuing the ‘business as usual’ approach to evaluating two-arm trials of audit and feedback interventions against usual care for common problems and settings is unlikely to contribute new generalizable findings. Future audit and feedback trials should incorporate evidence- and theory-based best practices, and address known gaps in the literature.

          Summary

          We offer an agenda for high-priority research topics for implementation researchers that focuses on reviewing best practices for designing audit and feedback interventions to optimize effectiveness.

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          Most cited references45

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          The theory of planned behavior

          Icek Ajzen (1991)
          Organizational Behavior and Human Decision Processes, 50(2), 179-211
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            Validation of the theoretical domains framework for use in behaviour change and implementation research

            Background An integrative theoretical framework, developed for cross-disciplinary implementation and other behaviour change research, has been applied across a wide range of clinical situations. This study tests the validity of this framework. Methods Validity was investigated by behavioural experts sorting 112 unique theoretical constructs using closed and open sort tasks. The extent of replication was tested by Discriminant Content Validation and Fuzzy Cluster Analysis. Results There was good support for a refinement of the framework comprising 14 domains of theoretical constructs (average silhouette value 0.29): ‘Knowledge’, ‘Skills’, ‘Social/Professional Role and Identity’, ‘Beliefs about Capabilities’, ‘Optimism’, ‘Beliefs about Consequences’, ‘Reinforcement’, ‘Intentions’, ‘Goals’, ‘Memory, Attention and Decision Processes’, ‘Environmental Context and Resources’, ‘Social Influences’, ‘Emotions’, and ‘Behavioural Regulation’. Conclusions The refined Theoretical Domains Framework has a strengthened empirical base and provides a method for theoretically assessing implementation problems, as well as professional and other health-related behaviours as a basis for intervention development.
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              The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory.

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                Author and article information

                Journal
                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central
                1748-5908
                2014
                17 January 2014
                : 9
                : 14
                Affiliations
                [1 ]Department of Family and Community Medicine, Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, University of Toronto, 77 Grenville Street, Toronto, ON M5S 1B3, Canada
                [2 ]Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105, USA
                [3 ]Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6, Canada
                [4 ]Centre for Outcomes Research and Effectiveness, Department of Clinical, Educational and Health Psychology University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
                [5 ]Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK
                [6 ]School of Health Sciences, City University London, Northampton Square, London EC1V 0HB, UK
                [7 ]Clinical Epidemiology Program, Ottawa Health Research Institute, University of Ottawa, 1053 Carling Avenue, Administration Building, Room 2-017, Ottawa, ON K1Y 4E9, Canada
                Article
                1748-5908-9-14
                10.1186/1748-5908-9-14
                3896824
                24438584
                e8794be2-1d2e-445b-b915-fe5c3c547053
                Copyright © 2014 Ivers et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 17 September 2013
                : 14 January 2014
                Categories
                Debate

                Medicine
                optimization,best practice,synthesis,audit and feedback,implementation
                Medicine
                optimization, best practice, synthesis, audit and feedback, implementation

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