Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section

TLDR

The guideline recommends actions to increase trial of labor and vaginal birth rates in women with a previous cesarean section. A randomized controlled trial with 76 physicians across 16 community hospitals compared audit and feedback to local opinion leader education, auditing charts for all 3,552 cases to assess guideline compliance. After 24 months, physicians educated by opinion leaders achieved 46% higher trial of labor and 85% higher vaginal birth rates, shorter hospital stays, and a reduced overall cesarean section rate, with no adverse outcomes, whereas audit and feedback had no effect compared to control. JAMA 1991;265:2202-2207.

Abstract

A randomized controlled trial with 76 physicians in 16 community hospitals evaluated audit and feedback and local opinion leader education as methods of encouraging compliance with a guideline for the management of women with a previous cesarean section. The guideline recommended clinical actions to increase trial of labor and vaginal birth rates. Charts for all 3552 cases in the study groups were audited. After 24 months the trial of labor and vaginal birth rates in the audit and feedback group were no different from those in the control group, but rates were 46% and 85% higher, respectively, among physicians educated by an opinion leader. Duration of hospital stay was lower in the opinion leader education group than in the other two groups. The overall cesarean section rate was reduced only in the opinion leader education group. There were no adverse clinical outcomes attributable to the interventions. The use of opinion leaders improved the quality of care. ( JAMA . 1991;265:2202-2207)