Is ownership more important than the scientific credibility of audit protocols? A survey of medical audit advisory groups

BACKGROUND: It is commonly accepted that ownership is an important factorin determining the acceptability and use of protocols or guidelines.OBJECTIVES: We aimed to determine whether Medical Audit Advisory Groups(MAAGs) are prepared to accept and use audit protocols developedsystematically by an external agency. METHOD: A postal questionnaire wassent to all 105 MAAG chairmen in England and Wales to seek their views onthe external development of protocols, the inclusion of evidence-basedprioritized criteria, the general design of the protocols issued by theLilly Audit Centre and the numbers of practices reported by MAAGs as makinguse of at least one of the first four protocols issued. RESULTS:Ninety-five MAAGs (90%) responded. Of these, 86% were in favour of theexternal development of protocols, and 98% and 94%, respectively, foundevidence-based and prioritized criteria valuable; 98% felt the overalldesign and content of the Audit Centre protocols were excellent or good. Atotal of 1018 practices was known to have made use of one of theseprotocols, 261 taking part in multi-practice audits organized by theirMAAGs. CONCLUSION: Ownership is not necessarily more important thanscientific credibility and/or perceived utility. Externally developed auditprotocols containing evidence-based, prioritized review criteria areacceptable to MAAGs, which are prepared to recommend their use in practice.Accordingly, such systematically developed protocols offer a promising andpractical method for improving clinical effectiveness. Further research isneeded, however, to determine the comparative impact on standards of careof protocols and other methods such as clinical guidelines.