Evaluating healthcare policies: the case of clinical audit

Since the introduction of national programmes of clinical audit in Britain much effort has gone into evaluating them. Many observational studies, both quantitative and qualitative, have been conducted, but when these provide evidence of changes in clinical practice or outcomes it is not possible to attribute these to audit. No controlled trials of the introduction of whole programmes of audit into healthcare organisations have been conducted and it is too late to conduct one now. Several trials of selected audit interventions in Britain and elsewhere have been performed, but their results are not easily generalisable to mainstream audit activity. We still do not know and will almost certainly never know, the scale of benefits or the true costs of the British national audit programmes. Evaluative research is worth while in indicating the types of audit activity and the types of audit organisation that are most likely to bring about change