Use of Criterion-based Clinical Audit to Improve the Quality of Obstetric Care: A Systematic Review

Although there is evidence that audit and feedback can improve health outcomes, little is known about the effect of audit on the quality of care from client's perspective. The aim of the current review was to explore the use of criterion-based audit to improve quality of obstetric care from both the midwives/doctors' and women/mothers' perspectives. Electronic searches of Cochrane Library, MEDLINE, and EMBASE were conducted. Randomized controlled trials (RCTs) and before-and-after studies that assessed the effect of criterion-based audit on health outcomes or women/mothers' perception of obstetric care were set as selection criteria. Data were extracted, analyzed using Revman 4.2 software, and results expressed as weighted mean differences for continuous data, and odds ratios for dichotomous data. Nineteen studies (one RCT and 18 before-and-after studies) involving 32,972 participants met our inclusion criteria. None of these studies assessed the effect of audit on quality from the women/mothers' perspective and none of the studies compared the effectiveness of different types of feedback. Ninety-five percentage (18/19) of studies showed significant improvement in at least one standard measured. Criterion-based audit has been used in obstetrics to improve quality from one dimension, namely the midwives/doctors' perspective. Midwives/doctors should consider the use of audit to improve quality of care from the mothers' view. There is need for well-designed RCTs to assess the effectiveness of different types of feedback in criterion-based audit.