Reinvigorating stagnant science: implementation laboratories and a meta-laboratory to efficiently advance the science of audit and feedback

Audit and feedback (A&F) is a commonly used quality improvement (QI) approach. A Cochrane review indicates that A&F is generally effective and leads to modest improvements in professional practice but with considerable variation in the observed effects. While we have some understanding of fa...

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Published in:	BMJ quality & safety Vol. 28; no. 5; pp. 416 - 423
Main Authors:	Grimshaw, JM, Ivers, Noah, Linklater, Stefanie, Foy, Robbie, Francis, Jill J, Gude, Wouter T, Hysong, Sylvia J, Alderson, Sarah, Boet, Sylvain, Brehaut, Jamie, Brown, Benjamin, Clarkson, Jan, Colquhoun, Heather, Keizer, Nicolette de, Desveaux, Laura, Dobell, Gail, Dunn, Sandra, Farrin, Amanda, Foy, Robbie C, Greenberg, Anna, Grimshaw, Jeremy M, Hartley, Suzanne, Horsley, Tanya, Ivers, Noah M, Landis-Lewis, Zach, London, Jane, Lorencatto, Fabiana, Michie, Susan, O’Connor, Denise, Peek, Niels, Presseau, Justin, Ramsay, Craig, Sales, Anne E, Sprague, Ann, Stanworth, Simon, Sykes, Michael, Taljaard, Monica, Thavorn, Kednapa, Walker, Mark, Walwyn, Rebecaa, Weiss, Debra, Willis, Thomas A, Witteman, Holly
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group Ltd 01.05.2019 BMJ Publishing Group LTD BMJ Publishing Group
Subjects:	Antibiotics audit and feedback Audits Feedback Health services Health Services Research Humans Hypotheses implementation science Intervention Laboratories Medical Audit - standards Outcome Assessment, Health Care Practice Patterns, Physicians' - standards Primary care Professional practice Professional Practice - standards Quality control Quality Improvement randomised controlled trial Randomized Controlled Trials as Topic Research and Reporting Methodology Researchers Science audit and feedback randomised controlled trial quality improvement implementation science
ISSN:	2044-5415, 2044-5423, 2044-5423
Online Access:	Get full text
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Abstract	Audit and feedback (A&F) is a commonly used quality improvement (QI) approach. A Cochrane review indicates that A&F is generally effective and leads to modest improvements in professional practice but with considerable variation in the observed effects. While we have some understanding of factors that enhance the effects of A&F, further research needs to explore when A&F is most likely to be effective and how to optimise it. To do this, we need to move away from two-arm trials of A&F compared with control in favour of head-to-head trials of different ways of providing A&F. This paper describes implementation laboratories involving collaborations between healthcare organisations providing A&F at scale, and researchers, to embed head-to-head trials into routine QI programmes. This can improve effectiveness while producing generalisable knowledge about how to optimise A&F. We also describe an international meta-laboratory that aims to maximise cross-laboratory learning and facilitate coordination of A&F research.
AbstractList	Audit and feedback (A&F) is a commonly used quality improvement (QI) approach. A Cochrane review indicates that A&F is generally effective and leads to modest improvements in professional practice but with considerable variation in the observed effects. While we have some understanding of factors that enhance the effects of A&F, further research needs to explore when A&F is most likely to be effective and how to optimise it. To do this, we need to move away from two-arm trials of A&F compared with control in favour of head-to-head trials of different ways of providing A&F. This paper describes implementation laboratories involving collaborations between healthcare organisations providing A&F at scale, and researchers, to embed head-to-head trials into routine QI programmes. This can improve effectiveness while producing generalisable knowledge about how to optimise A&F. We also describe an international meta-laboratory that aims to maximise cross-laboratory learning and facilitate coordination of A&F research. Audit and feedback (A&F) is a commonly used quality improvement (QI) approach. A Cochrane review indicates that A&F is generally effective and leads to modest improvements in professional practice but with considerable variation in the observed effects. While we have some understanding of factors that enhance the effects of A&F, further research needs to explore when A&F is most likely to be effective and how to optimise it. To do this, we need to move away from two-arm trials of A&F compared with control in favour of head-to-head trials of different ways of providing A&F. This paper describes implementation laboratories involving collaborations between healthcare organisations providing A&F at scale, and researchers, to embed head-to-head trials into routine QI programmes. This can improve effectiveness while producing generalisable knowledge about how to optimise A&F. We also describe an international meta-laboratory that aims to maximise cross-laboratory learning and facilitate coordination of A&F research.Audit and feedback (A&F) is a commonly used quality improvement (QI) approach. A Cochrane review indicates that A&F is generally effective and leads to modest improvements in professional practice but with considerable variation in the observed effects. While we have some understanding of factors that enhance the effects of A&F, further research needs to explore when A&F is most likely to be effective and how to optimise it. To do this, we need to move away from two-arm trials of A&F compared with control in favour of head-to-head trials of different ways of providing A&F. This paper describes implementation laboratories involving collaborations between healthcare organisations providing A&F at scale, and researchers, to embed head-to-head trials into routine QI programmes. This can improve effectiveness while producing generalisable knowledge about how to optimise A&F. We also describe an international meta-laboratory that aims to maximise cross-laboratory learning and facilitate coordination of A&F research.
Author	London, Jane Walker, Mark Grimshaw, JM Taljaard, Monica Presseau, Justin Hysong, Sylvia J Lorencatto, Fabiana Sprague, Ann Francis, Jill J Colquhoun, Heather Weiss, Debra Peek, Niels Ramsay, Craig Thavorn, Kednapa Walwyn, Rebecaa Willis, Thomas A Foy, Robbie C Landis-Lewis, Zach Boet, Sylvain Brehaut, Jamie Michie, Susan Greenberg, Anna Ivers, Noah M Sykes, Michael Stanworth, Simon Hartley, Suzanne Desveaux, Laura Dunn, Sandra Sales, Anne E Keizer, Nicolette de Dobell, Gail Grimshaw, Jeremy M Alderson, Sarah Foy, Robbie Horsley, Tanya Farrin, Amanda Ivers, Noah Witteman, Holly Linklater, Stefanie Brown, Benjamin Clarkson, Jan O’Connor, Denise Gude, Wouter T
AuthorAffiliation	1 Clinical Epidemiology Program , Ottawa Hospital Research Institute , Ottawa , Ontario , Canada 5 Leeds Institute of Health Sciences , University of Leeds , Leeds , UK 3 Women’s College Research Institute , Women’s College Hospital , Toronto , Ontario , Canada 8 Center for Innovations in Quality Effectiveness and Safety , Michael E. DeBakey Veterans Affairs Medical Center , Houston , Texas , United States 2 Department of Medicine , University of Ottawa , Ottawa , Ontario , Canada 4 Department of Family Medicine and Community Medicine , University of Toronto , Toronto , Ontario , Canada 7 Department of Medical Informatics , Academic Public Health Research Institute, Amsterdam UMC, University of Amsterdam , Amsterdam , Netherlands 6 Health Services Research and Management Division , City University of London , London , UK 9 Section of Health Services Research, Department of Medicine , Baylor College of Medicine , Houston , Texas , United States
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ContentType	Journal Article
Contributor	London, Jane Walker, Mark Taljaard, Monica Presseau, Justin Hysong, Sylvia J Lorencatto, Fabiana Sprague, Ann Colquhoun, Heather Francis, Jill J Weiss, Debra Peek, Niels Ramsay, Craig Thavorn, Kednapa Walwyn, Rebecaa Willis, Thomas A Foy, Robbie C Landis-Lewis, Zach Boet, Sylvain Brehaut, Jamie Michie, Susan Greenberg, Anna Ivers, Noah M Sykes, Michael Stanworth, Simon Hartley, Suzanne Desveaux, Laura Dunn, Sandra Sales, Anne E Keizer, Nicolette de Dobell, Gail Grimshaw, Jeremy M Alderson, Sarah Horsley, Tanya Farrin, Amanda O'Connor, Denise Witteman, Holly Brown, Benjamin Clarkson, Jan Linklater, Stefanie Gude, Wouter T
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Copyright	Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2019 Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0 Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2019
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Keywords	audit and feedback randomised controlled trial quality improvement implementation science
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References_xml	– volume: 216 start-page: 424 year: 2015 ident: R28 article-title: Inside the black box of audit and feedback: a laboratory study to explore determinants of improvement target selection by healthcare professionals in cardiac rehabilitation publication-title: Stud Health Technol Inform – volume: 11 year: 2015 ident: R17 article-title: A mixed methods evaluation of the maternal-newborn dashboard in Ontario: dashboard attributes, contextual factors, and facilitators and barriers to use: a study protocol publication-title: Implementation Science doi: 10.1186/s13012-016-0427-1 – volume: 164 start-page: 435 year: 2016 ident: R6 article-title: Practice feedback interventions: 15 suggestions for optimizing effectiveness publication-title: Ann Intern Med doi: 10.7326/M15-2248 – volume: 9 year: 2014 ident: R10 article-title: Application of theory to enhance audit and feedback interventions to increase the uptake of evidence-based transfusion practice: an intervention development protocol publication-title: Implementation Sci doi: 10.1186/s13012-014-0092-1 – volume: 12 year: 2017 ident: R27 article-title: Electronic audit and feedback intervention with action implementation toolbox to improve pain management in intensive care: protocol for a laboratory experiment and cluster randomised trial publication-title: Implement Sci doi: 10.1186/s13012-017-0594-8 – volume: 58 start-page: 319 year: 2003 ident: R22 article-title: Assessing the long-term effect of educational reminder messages on primary care radiology referrals publication-title: Clin Radiol doi: 10.1016/S0009-9260(02)00524-X – volume: 13 year: 2016 ident: R9 article-title: An audit and feedback intervention for reducing antibiotic prescribing in general dental practice: the rapid cluster randomised controlled trial publication-title: PLoS Med doi: 10.1371/journal.pmed.1002115 – volume: 9 year: 2014 ident: R5 article-title: No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention publication-title: Implementation Sci doi: 10.1186/1748-5908-9-14 – volume: 26 start-page: 54 year: 2017 ident: R7 article-title: Reporting and design elements of audit and feedback interventions: a secondary review publication-title: BMJ Qual Saf doi: 10.1136/bmjqs-2015-005004 – volume: 5 year: 2010 ident: R16 article-title: Using the theory of planned behaviour as a process evaluation tool in randomised trials of knowledge translation strategies: a case study from UK primary care publication-title: Implementation Sci doi: 10.1186/1748-5908-5-71 – volume: 21 start-page: 143 year: 2015 ident: R8 article-title: Radical incrementalism publication-title: Evaluation doi: 10.1177/1356389015578895 – volume: 11 year: 2016 ident: R15 article-title: A multidimensional approach to assessing intervention fidelity in a process evaluation of audit and feedback interventions to reduce unnecessary blood transfusions: a study protocol publication-title: Implement Sci doi: 10.1186/s13012-016-0528-x – volume: 85 start-page: 3 year: 2017 ident: R30 article-title: Embedding researchers in health service organizations improves research translation and health service performance: the Australian Hunter New England population health example publication-title: J Clin Epidemiol doi: 10.1016/j.jclinepi.2017.03.007 – volume: 383 start-page: 267 year: 2014 ident: R31 article-title: Reducing waste from incomplete or unusable reports of biomedical research publication-title: The Lancet doi: 10.1016/S0140-6736(13)62228-X – volume: 154 year: 2012 ident: R1 article-title: Audit and feedback: effects on professional practice and healthcare Outcomes publication-title: Cochrane Database Syst Rev doi: 10.1002/14651858.CD000259.pub3 – volume: 4 year: 2017 ident: R12 article-title: Negotiating tensions between theory and design in the development of Mailings for people recovering from acute coronary syndrome publication-title: JMIR Hum Factors doi: 10.2196/humanfactors.6502 – volume: 54 start-page: 599 year: 2015 ident: R24 article-title: Understanding and improving teamwork in organizations: a Scientifically based practical guide publication-title: Hum Resour Manage doi: 10.1002/hrm.21628 – volume: 12 year: 2017 ident: R14 article-title: The evaluation of enhanced feedback interventions to reduce unnecessary blood transfusions (AFFINITIE): protocol for two linked cluster randomised factorial controlled trials publication-title: Implement Sci doi: 10.1186/s13012-017-0614-8 – volume: 9 year: 2012 ident: R25 article-title: The Ottawa statement on the ethical design and conduct of cluster randomized trials publication-title: PLoS Med doi: 10.1371/journal.pmed.1001346 – volume: 17 year: 2017 ident: R18 article-title: Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework publication-title: BMC Health Serv Res doi: 10.1186/s12913-017-2031-8 – volume: 4 year: 2009 ident: R20 article-title: Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science publication-title: Implementation Sci doi: 10.1186/1748-5908-4-50 – volume: 388 start-page: 547 year: 2016 ident: R4 article-title: Reducing research waste with implementation laboratories publication-title: The Lancet doi: 10.1016/S0140-6736(16)31256-9 – volume: 26 start-page: 279 year: 2017 ident: R26 article-title: How does audit and feedback influence intentions of health professionals to improve practice? a laboratory experiment and field study in cardiac rehabilitation publication-title: BMJ Qual Saf doi: 10.1136/bmjqs-2015-004795 – volume: 29 start-page: 1534 year: 2014 ident: R2 article-title: Growing literature, stagnant science? Systematic review, meta-regression and cumulative analysis of audit and feedback interventions in health care publication-title: J Gen Intern Med doi: 10.1007/s11606-014-2913-y – volume: 383 start-page: 166 year: 2014 ident: R3 article-title: Increasing value and reducing waste in research design, conduct, and analysis publication-title: Lancet doi: 10.1016/S0140-6736(13)62227-8 – volume: 17 start-page: 26S year: 2000 ident: R19 article-title: Evaluating the cost-effectiveness of interventions designed to increase the utilization of evidence-based guidelines publication-title: Family Practice doi: 10.1093/fampra/17.suppl_1.S26 – volume: 40 start-page: 130 year: 2014 ident: R23 article-title: A review and integration of team composition models. moving toward a dynamic and temporal framework publication-title: Journal of Management – volume: 12 year: 2017 ident: R11 article-title: Testing feedback message framing and comparators to address prescribing of high-risk medications in nursing homes: protocol for a pragmatic, factorial, cluster-randomized trial publication-title: Implementation Science doi: 10.1186/s13012-017-0615-7 – volume: 5 year: 2010 ident: R29 article-title: The translation research in a dental setting (triads) programme protocol publication-title: Implementation Science doi: 10.1186/1748-5908-5-57 – volume: 85 start-page: 3 year: 2017 article-title: Embedding researchers in health service organizations improves research translation and health service performance: the Australian Hunter New England population health example publication-title: J Clin Epidemiol doi: 10.1016/j.jclinepi.2017.03.007 – volume: 154 year: 2012 article-title: Audit and feedback: effects on professional practice and healthcare Outcomes publication-title: Cochrane Database Syst Rev doi: 10.1002/14651858.CD000259.pub3 – volume: 9 year: 2014 article-title: Application of theory to enhance audit and feedback interventions to increase the uptake of evidence-based transfusion practice: an intervention development protocol publication-title: Implementation Sci doi: 10.1186/s13012-014-0092-1 – volume: 4 year: 2017 article-title: Negotiating tensions between theory and design in the development of Mailings for people recovering from acute coronary syndrome publication-title: JMIR Hum Factors doi: 10.2196/humanfactors.6502 – volume: 11 year: 2015 article-title: A mixed methods evaluation of the maternal-newborn dashboard in Ontario: dashboard attributes, contextual factors, and facilitators and barriers to use: a study protocol publication-title: Implementation Science doi: 10.1186/s13012-016-0427-1 – volume: 11 year: 2016 article-title: A multidimensional approach to assessing intervention fidelity in a process evaluation of audit and feedback interventions to reduce unnecessary blood transfusions: a study protocol publication-title: Implement Sci doi: 10.1186/s13012-016-0528-x – volume: 13 year: 2016 article-title: An audit and feedback intervention for reducing antibiotic prescribing in general dental practice: the rapid cluster randomised controlled trial publication-title: PLoS Med doi: 10.1371/journal.pmed.1002115 – volume: 5 year: 2010 article-title: Using the theory of planned behaviour as a process evaluation tool in randomised trials of knowledge translation strategies: a case study from UK primary care publication-title: Implementation Sci doi: 10.1186/1748-5908-5-71 – volume: 164 start-page: 435 year: 2016 article-title: Practice feedback interventions: 15 suggestions for optimizing effectiveness publication-title: Ann Intern Med doi: 10.7326/M15-2248 – volume: 388 start-page: 547 year: 2016 article-title: Reducing research waste with implementation laboratories publication-title: The Lancet doi: 10.1016/S0140-6736(16)31256-9 – volume: 12 year: 2017 article-title: Electronic audit and feedback intervention with action implementation toolbox to improve pain management in intensive care: protocol for a laboratory experiment and cluster randomised trial publication-title: Implement Sci doi: 10.1186/s13012-017-0594-8 – volume: 383 start-page: 267 year: 2014 article-title: Reducing waste from incomplete or unusable reports of biomedical research publication-title: The Lancet doi: 10.1016/S0140-6736(13)62228-X – volume: 58 start-page: 319 year: 2003 article-title: Assessing the long-term effect of educational reminder messages on primary care radiology referrals publication-title: Clin Radiol doi: 10.1016/S0009-9260(02)00524-X – volume: 40 start-page: 130 year: 2014 article-title: A review and integration of team composition models. moving toward a dynamic and temporal framework publication-title: Journal of Management – volume: 17 year: 2017 article-title: Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework publication-title: BMC Health Serv Res doi: 10.1186/s12913-017-2031-8 – volume: 26 start-page: 279 year: 2017 article-title: How does audit and feedback influence intentions of health professionals to improve practice? a laboratory experiment and field study in cardiac rehabilitation publication-title: BMJ Qual Saf doi: 10.1136/bmjqs-2015-004795 – volume: 17 start-page: 26S year: 2000 article-title: Evaluating the cost-effectiveness of interventions designed to increase the utilization of evidence-based guidelines publication-title: Family Practice doi: 10.1093/fampra/17.suppl_1.S26 – volume: 26 start-page: 54 year: 2017 article-title: Reporting and design elements of audit and feedback interventions: a secondary review publication-title: BMJ Qual Saf doi: 10.1136/bmjqs-2015-005004 – volume: 12 year: 2017 article-title: The evaluation of enhanced feedback interventions to reduce unnecessary blood transfusions (AFFINITIE): protocol for two linked cluster randomised factorial controlled trials publication-title: Implement Sci doi: 10.1186/s13012-017-0614-8 – volume: 383 start-page: 166 year: 2014 article-title: Increasing value and reducing waste in research design, conduct, and analysis publication-title: Lancet doi: 10.1016/S0140-6736(13)62227-8 – volume: 29 start-page: 1534 year: 2014 article-title: Growing literature, stagnant science? Systematic review, meta-regression and cumulative analysis of audit and feedback interventions in health care publication-title: J Gen Intern Med doi: 10.1007/s11606-014-2913-y – volume: 12 year: 2017 article-title: Testing feedback message framing and comparators to address prescribing of high-risk medications in nursing homes: protocol for a pragmatic, factorial, cluster-randomized trial publication-title: Implementation Science doi: 10.1186/s13012-017-0615-7 – volume: 5 year: 2010 article-title: The translation research in a dental setting (triads) programme protocol publication-title: Implementation Science doi: 10.1186/1748-5908-5-57 – volume: 21 start-page: 143 year: 2015 article-title: Radical incrementalism publication-title: Evaluation doi: 10.1177/1356389015578895 – volume: 4 year: 2009 article-title: Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science publication-title: Implementation Sci doi: 10.1186/1748-5908-4-50 – volume: 9 year: 2012 article-title: The Ottawa statement on the ethical design and conduct of cluster randomized trials publication-title: PLoS Med doi: 10.1371/journal.pmed.1001346 – volume: 9 year: 2014 article-title: No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention publication-title: Implementation Sci doi: 10.1186/1748-5908-9-14 – volume: 54 start-page: 599 year: 2015 article-title: Understanding and improving teamwork in organizations: a Scientifically based practical guide publication-title: Hum Resour Manage doi: 10.1002/hrm.21628 – volume: 216 start-page: 424 year: 2015 article-title: Inside the black box of audit and feedback: a laboratory study to explore determinants of improvement target selection by healthcare professionals in cardiac rehabilitation publication-title: Stud Health Technol Inform – volume: 4 year: 2017 ident: 2025090413085073000_28.5.416.12 article-title: Negotiating tensions between theory and design in the development of Mailings for people recovering from acute coronary syndrome publication-title: JMIR Hum Factors doi: 10.2196/humanfactors.6502 – volume: 216 start-page: 424 year: 2015 ident: 2025090413085073000_28.5.416.28 article-title: Inside the black box of audit and feedback: a laboratory study to explore determinants of improvement target selection by healthcare professionals in cardiac rehabilitation publication-title: Stud Health Technol Inform – ident: 2025090413085073000_28.5.416.19 doi: 10.1093/fampra/17.suppl_1.S26 – ident: 2025090413085073000_28.5.416.3 doi: 10.1016/S0140-6736(13)62227-8 – ident: 2025090413085073000_28.5.416.17 doi: 10.1186/s13012-016-0427-1 – volume: 85 start-page: 3 year: 2017 ident: 2025090413085073000_28.5.416.30 article-title: Embedding researchers in health service organizations improves research translation and health service performance: the Australian Hunter New England population health example publication-title: J Clin Epidemiol doi: 10.1016/j.jclinepi.2017.03.007 – ident: 2025090413085073000_28.5.416.14 doi: 10.1186/s13012-017-0614-8 – volume: 9 year: 2012 ident: 2025090413085073000_28.5.416.25 article-title: The Ottawa statement on the ethical design and conduct of cluster randomized trials publication-title: PLoS Med doi: 10.1371/journal.pmed.1001346 – ident: 2025090413085073000_28.5.416.26 doi: 10.1136/bmjqs-2015-004795 – ident: 2025090413085073000_28.5.416.13 – ident: 2025090413085073000_28.5.416.29 doi: 10.1186/1748-5908-5-57 – ident: 2025090413085073000_28.5.416.15 doi: 10.1186/s13012-016-0528-x – volume: 13 year: 2016 ident: 2025090413085073000_28.5.416.9 article-title: An audit and feedback intervention for reducing antibiotic prescribing in general dental practice: the rapid cluster randomised controlled trial publication-title: PLoS Med doi: 10.1371/journal.pmed.1002115 – ident: 2025090413085073000_28.5.416.10 doi: 10.1186/s13012-014-0092-1 – ident: 2025090413085073000_28.5.416.18 doi: 10.1186/s12913-017-2031-8 – ident: 2025090413085073000_28.5.416.24 doi: 10.1002/hrm.21628 – ident: 2025090413085073000_28.5.416.7 doi: 10.1136/bmjqs-2015-005004 – ident: 2025090413085073000_28.5.416.11 doi: 10.1186/s13012-017-0615-7 – ident: 2025090413085073000_28.5.416.22 doi: 10.1016/S0009-9260(02)00524-X – volume: 383 start-page: 267 year: 2014 ident: 2025090413085073000_28.5.416.31 article-title: Reducing waste from incomplete or unusable reports of biomedical research publication-title: The Lancet doi: 10.1016/S0140-6736(13)62228-X – ident: 2025090413085073000_28.5.416.2 doi: 10.1007/s11606-014-2913-y – ident: 2025090413085073000_28.5.416.8 doi: 10.1177/1356389015578895 – volume: 354 start-page: i4079 volume-title: BMJ (clinical research) year: 2016 ident: 2025090413085073000_28.5.416.21 – volume: 388 start-page: 547 year: 2016 ident: 2025090413085073000_28.5.416.4 article-title: Reducing research waste with implementation laboratories publication-title: The Lancet doi: 10.1016/S0140-6736(16)31256-9 – ident: 2025090413085073000_28.5.416.5 doi: 10.1186/1748-5908-9-14 – ident: 2025090413085073000_28.5.416.1 doi: 10.1002/14651858.CD000259.pub3 – ident: 2025090413085073000_28.5.416.23 doi: 10.1177/0149206313503014 – ident: 2025090413085073000_28.5.416.27 doi: 10.1186/s13012-017-0594-8 – ident: 2025090413085073000_28.5.416.20 doi: 10.1186/1748-5908-4-50 – volume: 164 start-page: 435 year: 2016 ident: 2025090413085073000_28.5.416.6 article-title: Practice feedback interventions: 15 suggestions for optimizing effectiveness publication-title: Ann Intern Med doi: 10.7326/M15-2248 – ident: 2025090413085073000_28.5.416.16 doi: 10.1186/1748-5908-5-71
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Snippet	Audit and feedback (A&F) is a commonly used quality improvement (QI) approach. A Cochrane review indicates that A&F is generally effective and leads to modest...
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SubjectTerms	Antibiotics audit and feedback Audits Feedback Health services Health Services Research Humans Hypotheses implementation science Intervention Laboratories Medical Audit - standards Outcome Assessment, Health Care Practice Patterns, Physicians' - standards Primary care Professional practice Professional Practice - standards Quality control Quality Improvement randomised controlled trial Randomized Controlled Trials as Topic Research and Reporting Methodology Researchers Science
Title	Reinvigorating stagnant science: implementation laboratories and a meta-laboratory to efficiently advance the science of audit and feedback
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