Abstract
BackgroundThere is growing interest in the impact of national clinical audit programmes on the quality of healthcare. There is also an evolving evidence-base for enhancing the design and delivery of audit and feedback. We assessed the extent to which a sample of UK national clinical audit feedback reports met a set of good practice criteria over three time points.MethodsWe undertook three cross-sectional content analyses. We developed good practice criteria for the content and delivery of feedback based upon evidence, behavioural theory and expert opinion. We applied these to a feedback reports from 23 national audits listed on the Healthcare Quality Improvement Partnership (HQIP) website in November 2015. We repeated our assessments in January 2017 for 20 repeat feedback reports, after HQIP had published reporting guidance for national audits, and in August 2019 for a further 14 repeat feedback reports. We verified our assessments, where possible, with audit leads.ResultsFeedback reports consistently included strengths at baseline, including past or planned repeated audit cycles (21; 91%), stating the importance of the topic in relation to patient care (22; 93%), using multi-modal data presentation (23; 100%), and summarising key findings (23; 100%).We observed improvements over subsequent assessments, so that by 2019, at least 13 out of 14 (93%) feedback reports presented easily identifiable key findings and recommendations, linked recommendations to audit standards, and proposed easily identifiable action plans. Whilst the use of regional comparators did not improve, audit leads highlighted that programmes now provide local data via additional means.The main shortcoming was the time lag between data collection and feedback; none of the 14 reports assessed in 2019 presented performance data less than 6 months old. Audit leads highlighted that some of these data might be available via programme websites.ConclusionWe identified increased adherence to good practice in feedback by national clinical audit programmes that may enhance their impact on service delivery and outcomes. There is scope for improvement, especially in the recency of performance data. With further refinements, a criterion-based assessment offers an efficient means of monitoring the quality of national clinical audit feedback reports.
Highlights
There is growing interest in the impact of national clinical audit programmes on the quality of healthcare
National clinical audit programmes have a key role in driving improvements in population healthcare and health but the extent to which they employ best practice in audit and feedback is unknown
We demonstrated improvements over time and significant scope for enhancing impact, including the need to reduce the time lag between data collection and feedback
Summary
There is growing interest in the impact of national clinical audit programmes on the quality of healthcare. Audit and feedback aims to improve patient care by reviewing clinical performance against explicit standards. The National Clinical Audit and Patient Outcomes Programme (NCAPOP) supports national clinical audits and confidential enquiries into patient outcomes commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England and devolved nations. These national clinical audit programmes address a variety of priorities across secondary care, such as stroke and cancer, and in primary care, such as diabetes. National clinical audit programmes aim to improve health outcomes by enabling those who commission, deliver and receive healthcare to measure and improve care delivery. There is a growing recognition of the need for audit programmes to place as much emphasis on delivering effective feedback as on data collection if they are to achieve population impacts [5, 6]
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