Improving the development and implementation of audit and feedback systems to support healthcare workers in limiting antimicrobial resistance in the hospital: a scoping review. (Preprint)

Background: For eHealth technologies in general, and audit and feedback (AF) systems specifically, integrating interdisciplinary theoretical underpinnings is essential as it increases the likelihood of achieving desired outcomes by ensuring a fit between the eHealth technology, stakeholders, and their context. Additionally, reporting on the development and implementation process of AF systems, including substantiations of choices, enables the identification of best practices and accumulation of knowledge across studies, yet is often not elaborated on in publications. Objective: Therefore, this scoping review aims to 1) provide insights in development and implementation strategies for AF systems for a real-world problem that threatens modern healthcare care: antimicrobial resistance (AMR), and 2) provide an interdisciplinary conceptual framework that can serve as a checklist and guidance to make informed choices in the development and implementation of future AF systems. Methods: A scoping review was conducted by querying PubMed, Scopus, Web of Science, IEEE Xplore Digital Library, and EMBASE (?2010) for studies describing the development and/or implementation process of an audit and feedback system for AMR or infections in hospitals. Studies reporting on effectiveness or impact only were excluded. Three independent reviewers performed study selection, and two reviewers constructed the conceptual framework through axial and selective coding of often used theories, models and frameworks (TMFs) from literature on AF and eHealth development and implementation. Subsequently, the conceptual framework was used for the systematic extraction and interpretation of studies' descriptions of the AF systems and their development and implementation. Results: The search resulted in 2125 studies screened for eligibility, of which 12 studies (2012-2020) were included. These studies described the development and/or implementation processes heterogeneously in terms of study aims, study targets, target groups, methods, and theoretical underpinnings. Few studies explicitly explained how choices for the development and implementation of AF-systems were substantiated by the TMFs. The conceptual framework provided insights in what is reported on the development and implementation process and revealed underreported AF system constructs (e.g. AF system design, engagement with the AF system, and comparison, goal setting and action planning), and development and implementation (e.g. champions) constructs. Conclusions: This scoping review showed current heterogeneous reporting of AF systems and their development and implementation processes and exemplified how interdisciplinary TMFs can (and should) be balanced in a conceptual framework to capture relevant AF system and development/implementation constructs. Thereby, it provides a concrete checklist and overall guidance that supports the professionalization and harmonization of AF system development and implementation. For the development and implementation of future AF-systems, and other eHealth technologies, researchers and HCWs should be supported in selecting and integrating TMFs into their development and implementation process and encouraged to explicitly report on theoretical underpinnings and substantiation of choices.