Overview

There is now extensive evidence from every country in which it has been sought that there is a gap between the health care that patients receive, and the practice that is recommended. In both primary and secondary care there are unwarranted variations in practice and in the resulting outcomes, and which cannot be explained by characteristics of the patients. While it is difficult to ascertain the extent to which measures for tackling this exist in all 53 Member States of the World Health Organization’s European Region, concrete examples can be identified in each of the 27 European Union Member States. In particular, there is growing interest in the use of audit and feedback for health professionals.

The material in this policy summary is largely based on a systematic review of the effectiveness of audit and feedback in changing clinical practice, and a review of experiences of how audit and feedback have been used in clinical practice. The studies presented in this policy summary show that audit and feedback can be used in almost all health care settings. Implementation of audit and feedback requires clear goals and a thorough analysis of the health care environment in question, especially if this approach is combined with incentives or penalties, or is made mandatory. No strong evidence has been identified indicating that these combinations significantly improve outcomes and thus the health care delivered. The experience arising from some major initiatives taking place in certain European countries may provide some of the required evidence in the future.