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      Revitalising audit and feedback to improve patient care

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          Abstract

          Audit and feedback are widely used in quality improvement. Robbie Foy and colleagues argue that their full potential to improve patient care could be realised through a more evidence based and imaginative approach

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          Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial

          Michael Hallsworth, Tim Chadborn, Anna Sallis … (2016)
          Summary Background Unnecessary antibiotic prescribing contributes to antimicrobial resistance. In this trial, we aimed to reduce unnecessary prescriptions of antibiotics by general practitioners (GPs) in England. Methods In this randomised, 2 × 2 factorial trial, publicly available databases were used to identify GP practices whose prescribing rate for antibiotics was in the top 20% for their National Health Service (NHS) Local Area Team. Eligible practices were randomly assigned (1:1) into two groups by computer-generated allocation sequence, stratified by NHS Local Area Team. Participants, but not investigators, were blinded to group assignment. On Sept 29, 2014, every GP in the feedback intervention group was sent a letter from England's Chief Medical Officer and a leaflet on antibiotics for use with patients. The letter stated that the practice was prescribing antibiotics at a higher rate than 80% of practices in its NHS Local Area Team. GPs in the control group received no communication. The sample was re-randomised into two groups, and in December, 2014, GP practices were either sent patient-focused information that promoted reduced use of antibiotics or received no communication. The primary outcome measure was the rate of antibiotic items dispensed per 1000 weighted population, controlling for past prescribing. Analysis was by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN32349954, and has been completed. Findings Between Sept 8 and Sept 26, 2014, we recruited and assigned 1581 GP practices to feedback intervention (n=791) or control (n=790) groups. Letters were sent to 3227 GPs in the intervention group. Between October, 2014, and March, 2015, the rate of antibiotic items dispensed per 1000 population was 126·98 (95% CI 125·68–128·27) in the feedback intervention group and 131·25 (130·33–132·16) in the control group, a difference of 4·27 (3·3%; incidence rate ratio [IRR] 0·967 [95% CI 0·957–0·977]; p<0·0001), representing an estimated 73 406 fewer antibiotic items dispensed. In December, 2014, GP practices were re-assigned to patient-focused intervention (n=777) or control (n=804) groups. The patient-focused intervention did not significantly affect the primary outcome measure between December, 2014, and March, 2015 (antibiotic items dispensed per 1000 population: 135·00 [95% CI 133·77–136·22] in the patient-focused intervention group and 133·98 [133·06–134·90] in the control group; IRR for difference between groups 1·01, 95% CI 1·00–1·02; p=0·105). Interpretation Social norm feedback from a high-profile messenger can substantially reduce antibiotic prescribing at low cost and at national scale; this outcome makes it a worthwhile addition to antimicrobial stewardship programmes. Funding Public Health England.
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            Creating a Learning Health System through Rapid-Cycle, Randomized Testing

            Leora Horwitz, Masha Kuznetsova, Simon A. Jones (2019)
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              How to improve healthcare improvement—an essay by Mary Dixon-Woods

              Mary Dixon-Woods (2019)
              As improvement practice and research begin to come of age, Mary Dixon-Woods considers the key areas that need attention if we are to reap their benefits
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                Author and article information

                Contributors
                Robbie Foy: Role: professor of primary care
                Mirek Skrypak: Role: associate director for quality and development
                Sarah Alderson: Role: clinical lecturer in primary care and Wellcome ISSF fellow
                Noah Michael Ivers: Role: clinician scientist
                Bren McInerney: Role: community volunteer
                Jill Stoddart: Role: director of operations
                Jane Ingham: Role: chief executive officer
                Danny Keenan: Role: medical director
                Journal
                Journal ID (nlm-ta): BMJ
                Journal ID (iso-abbrev): BMJ
                Journal ID (publisher-id): BMJ-UK
                Journal ID (hwp): bmj
                Title: The BMJ
                Publisher: BMJ Publishing Group Ltd.
                ISSN (Print): 0959-8138
                ISSN (Electronic): 1756-1833
                Publication date Collection: 2020
                Publication date (Electronic): 27 February 2020
                Volume: 368
                Electronic Location Identifier: m213
                Affiliations
                [1 ]Leeds Institute of Health Sciences, Leeds, UK
                [2 ]Healthcare Quality Improvement Partnership, London, UK
                [3 ]Women’s College Hospital, Toronto, ON, Canada
                [4 ]Gloucerstershire, UK
                Author notes
                Correspondence to: M Skrypak mirek.skrypak@ 123456hqip.org.uk
                Article
                Publisher ID: foyr053270
                DOI: 10.1136/bmj.m213
                PMC ID: 7190377
                PubMed ID: 32107249
                SO-VID: feb836a1-b171-4caa-a860-6707132b2bf0
                Copyright © © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Categories
                Subject: Analysis
                Series title: Quality Improvement

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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