LAUSR

Key Points Question What are the effects of 2 theoretically informed enhancements to feedback delivered by a national clinical audit program on the appropriate use of blood transfusions? Findings In this comparison of linked 2 × 2 cluster randomized trials comprising 135 clusters in a surgical trial (2714 patients) and 134 clusters in a hematological trial (4439 patients) in which hospitals were randomized to enhanced content feedback or enhanced support for staff, no benefit of the enhanced interventions over standard feedback was observed in increasing appropriate use of blood transfusions. There was incomplete local engagement with the audit program as a whole across the intervention and standard feedback groups. Meaning Given the considerable uncertainty about how to optimize the full potential of auditing and feedback in routine practice, these findings suggest a need to develop and evaluate ways of strengthening local responses to feedback.