The effect of audit and feedback on immunization delivery - A systematic review

Objective: To assess the effective of audit and feedback (A&F) on immunizat ion delivery by health care professionals. Design: Systematic review of published literature. Main Outcome Measures: Changes in immunization rates. Methods: We searched Medline between 1966 and 1997. We obtained additional studies from back-searching; reference lists and the files of study collabo rators. We included studies that were written in English, that included aud it and feedback in at least one arm of the study, that studied universally recommended childhood or adult vaccines, and that provided immunization cov erage data. Two reviewers read studies independently and abstracted using a validated checklist. Study quality was assessed using criteria standardize d by the Cochrane Collaboration. Differences between reviewers were resolve d by consensus. Results: The search process resulted in 60 citations; 44 were fully reviewe d and 15 met eligibility criteria. Five were randomized trials. Twelve of t he fifteen studies found that A&F, alone or in combination with other inter ventions, were associated with improvements in immunization rates. The magn itude of the effect varied from -17% to 149% change, Study design heterogen eity precluded statistical pooling of study results. Conclusion: The evidence available from published studies suggests that A&F alone may be an effective strategy for improving immunization rates. The n umber of well-conducted studies is small, and the effect is variable. Addit ional well-designed studies are needed to identify the independent effects of A&F, optimal format and frequency of A&F, and to examine its long-term e ffect on provider immunization practices and costs.