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BMJ Qual Saf. 2019 May;28(5):416-423. doi: 10.1136/bmjqs-2018-008355. Epub 2019 Mar 9.

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

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Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Department of Family Medicine and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Health Services Research and Management Division, City University of London, London, UK.
Department of Medical Informatics, Academic Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States.
Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States.


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; implementation science; quality improvement; randomised controlled trial

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