Low-value care is common, and addressing this requires more than list making because guidelines do not self-implement. A concerted effort is needed to address system-, provider- and patient-level factors that play a role. In this commentary, we argue that a foundational element of any systematic approach to de-implement low-value care will include a carefully planned, ongoing process of measurement against standards (i.e., audit) and provision of the resulting data to health professionals (i.e., feedback). Audit and feedback can work well but do not always lead to substantial changes – the devil is in the details regarding how the initiative is designed and delivered. Currently, most physicians do not consider active reflection on practice data and working with colleagues to make changes to practice patterns based on that data to be a core function of their job. If we are to be successful in addressing low-value care, this must change. Fortunately, there is an abundance of evidence upon which to draw to develop effective audit and feedback initiatives. We describe a vision: a physician-led program in data-driven continuing professional development that could lead to sustainable improvement in quality of care.
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