Audit & Feedback on clinical  guideline adherence: a systematic review and meta-analysis of RCTs

AIM: To examine which design characteristics, cointerventions and contextual factors explain variance in effectiveness of Audit & Feedback (A&F) interventions targeting clinical guideline adherence of hospital-based medical specialists.

INTRODUCTION: Clinical guideline adherence varies, resulting in low value care. A&F can effectively improve guideline adherence, but it is unclear how to design A&F for optimal effectiveness.

METHODS: Systematic Review and meta-analysis of RCTs.

•Screening: 4678 articles ti/ab, 87 full-text, 41 studies were included

 •Two reviewers independently screened articles. Data on design characteristics, co-interventions, contextual factors and outcomes were extracted. Risk of Bias was assessed using the ROB2 tools.

 •Results were described descriptively and when appropriate a meta-analysis using a random effects model was performed.

RESULTS: 41 studies were included with 3 types of comparisons:

  1) A&F vs. No intervention     (N=14)

  2) A&F vs. Other intervention    (N=12)

  3) A&F vs. A&F     (N=21)

Meta-analysis showed a significant improvement of clinical guideline adherence:
  A&F vs No intervention:      OR 1.19 (95% CI 1.16–1.23, I²=0.0%,   N=14)
  A&F vs. Other intervention:      OR 1.80 (95% CI 1.42–2.28, I²=56.3%, N=9)

Risk of bias was low in 6 six studies, with some risk in 19 studies and high in 16 studies. 

Of note:
- Within study variation in effect size was large, between different guideline indicators and between intervention sites.
- Across study variation in effect size was small, while variation in design characteristics, cointerventions and context was large.

CONCLUSION: