Effect of Audit and Feedback on Physician Adherence to Clinical Practice Guidelines for Pneumonia and Sepsis

Am J Med Qual. 2019 May/Jun;34(3):217-225. doi: 10.1177/1062860618796947. Epub 2018 Sep 12.

Abstract

The objective was to estimate the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for severe sepsis. The authors performed a quasi-experiment using a stepped wedge design at a single urban safety net hospital. Attending emergency physicians were randomized into 6 clusters. Once a cluster crossed into the intervention group, physicians in that cluster began receiving detailed feedback with blinded peer comparison on their adherence to guidelines for pneumonia and sepsis. Feedback with blinded peer comparison significantly improved guideline adherence from 52% without feedback to 65% with feedback (difference = 13%, 95% confidence interval = 4% to 22%). In adjusted analyses, the odds of providing guideline adherent care were 1.8 (95% confidence interval = 1.01-3.2) after the introduction of feedback with blinded peer comparison. Feedback with blinded peer comparison significantly improved emergency physician guideline adherence.

Keywords: emergency medicine; feedback; guideline adherence; infectious disease; peer comparison.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Emergency Medicine / standards
  • Emergency Medicine / statistics & numerical data
  • Female
  • Formative Feedback*
  • Guideline Adherence* / statistics & numerical data
  • Humans
  • Male
  • Medical Audit*
  • Middle Aged
  • Pneumonia / drug therapy
  • Pneumonia / therapy*
  • Practice Patterns, Physicians'* / statistics & numerical data
  • Sepsis / therapy*

Substances

  • Anti-Bacterial Agents