EVALUATION OF MEDICAL AUDIT

Objective - To review current knowledge of the effectiveness of medica l audit programmes as a whole and of specific interventions within the se programmes, as a means of changing clinical behaviour. Criteria for inclusion and exclusion of published reports - Articles Listed on Med line from 1985-92 with key words ''quality assurance'' or ''medical au dit'', and ''evaluation'' and relevant references from these articles, and from recently published reviews and reports on medical audit, wer e included. Excluded were simple descriptions of audit activity, repli cations of previous work, and publication in a language other than Eng lish. Results - Evaluation of entire programmes of medical audit is un usual. Most reports concern specific interventions and focus particula rly on the scientific and technical aspects of quality. These interven tions may be classified by the means through which they attempt to ach ieve desired changes: patient characteristics; physician characteristi cs; administrative and organisational structures; and financial incent ives. Conclusions - Knowledge about effective methods of bringing abou t specific changes in clinical behaviour is rudimentary. Impact is hig hly dependent on local factors, so generalisation of results to other settings is difficult. More qualitative research is needed to define t he local factors which influence results.