Effect of medical record audit and feedback on residents' compliance with preventive health care guidelines

Purpose. To examine the effect on residents' compliance with preventive health guidelines of an intensive quality improvement program using medical record audits and individualized feedback. Method. The before-and-after study was set in a general internal medicine clinic at a military teaching hospital. In 1995, the authors retrospectively reviewed 280 medical records to determine whether, after the hospital had started an audit-and-feedback program in 1994, residents' compliance rates had risen for preventive health interventions. The study looked at both audited and non-audited interventions. Results. The residents' compliance rates significantly im proved for the audited interventions (tetanus immunization, breast examination, and rectal examination). They also had higher compliance rates for six of the seven non-audited interventions. Conclusions. An intensive medical record audit with individualized feedback can produce exceptionally high levels of compliance with preventive care practices among internal medicine residents. Furthermore, the improved compliance is generalizable to other health care measures not directly targeted for audit.