PDF(Pubmed)
Abstract：
BACKGROUND: Up to 30% of diagnostic imaging (DI) tests may be unnecessary, leading to increased healthcare costs and the possibility of patient harm. The primary objective of this systematic review was to assess the effect of audit and feedback (AF) interventions directed at healthcare providers on reducing image ordering. The secondary objective was to examine the effect of AF on the appropriateness of DI ordering.
METHODS: Studies were identified using MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov registry on December 22nd, 2022. Studies were included if they were randomized control trials (RCTs), targeted healthcare professionals, and studied AF as the sole intervention or as the core component of a multi-faceted intervention. Risk of bias for each study was evaluated using the Cochrane risk of bias tool. Meta-analyses were completed using RevMan software and results were displayed in forest plots.
RESULTS: Eleven RCTs enrolling 4311 clinicians or practices were included. AF interventions resulted in 1.5 fewer image test orders per 1000 patients seen than control interventions (95% confidence interval (CI) for the difference -2.6 to -0.4, p-value = 0.009). The effect of AF on appropriateness was not statistically significant, with a 3.2% (95% CI -1.5 to 7.7%, p-value = 0.18) greater likelihood of test orders being considered appropriate with AF vs control interventions. The strength of evidence was rated as moderate for the primary objective but was very low for the appropriateness outcome because of risk of bias, inconsistency in findings, indirectness, and imprecision.
CONCLUSIONS: AF interventions are associated with a modest reduction in total DI ordering with moderate certainty, suggesting some benefit of AF. Individual studies document effects of AF on image order appropriateness ranging from a non-significant trend toward worsening to a highly significant improvement, but the weighted average effect size from the meta-analysis is not statistically significant with very low certainty.
METHODS: Studies were identified using MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov registry on December 22nd, 2022. Studies were included if they were randomized control trials (RCTs), targeted healthcare professionals, and studied AF as the sole intervention or as the core component of a multi-faceted intervention. Risk of bias for each study was evaluated using the Cochrane risk of bias tool. Meta-analyses were completed using RevMan software and results were displayed in forest plots.
RESULTS: Eleven RCTs enrolling 4311 clinicians or practices were included. AF interventions resulted in 1.5 fewer image test orders per 1000 patients seen than control interventions (95% confidence interval (CI) for the difference -2.6 to -0.4, p-value = 0.009). The effect of AF on appropriateness was not statistically significant, with a 3.2% (95% CI -1.5 to 7.7%, p-value = 0.18) greater likelihood of test orders being considered appropriate with AF vs control interventions. The strength of evidence was rated as moderate for the primary objective but was very low for the appropriateness outcome because of risk of bias, inconsistency in findings, indirectness, and imprecision.
CONCLUSIONS: AF interventions are associated with a modest reduction in total DI ordering with moderate certainty, suggesting some benefit of AF. Individual studies document effects of AF on image order appropriateness ranging from a non-significant trend toward worsening to a highly significant improvement, but the weighted average effect size from the meta-analysis is not statistically significant with very low certainty.
摘要：
背景：多达30％的诊断成像（DI）测试可能是不必要的，导致医疗费用增加和患者受到伤害的可能性。本系统评价的主要目的是评估针对医疗保健提供者的审核和反馈（AF）干预措施对减少图像订购的影响。次要目标是检查AF对DI排序适当性的影响。
方法：使用MEDLINE确定研究，EMBASE,CINAHL,12月22日，Cochrane中央对照试验登记册和ClinicalTrials.gov注册表，2022年。如果研究是随机对照试验(RCTs)，有针对性的医疗保健专业人员，并研究了房颤作为唯一干预或多方面干预的核心组成部分。使用Cochrane偏差风险工具评估每个研究的偏差风险。使用RevMan软件完成荟萃分析，并在森林地块上显示结果。
结果：纳入了11个纳入4311名临床医生或实践的RCTs。AF干预导致每1000名患者的图像测试顺序比对照干预少1.5次（差异为-2.6至-0.4的95％置信区间（CI），p值=0.009）。房颤对适宜性的影响无统计学意义，3.2%(95%CI-1.5至7.7%，p值=0.18）房颤与对照干预措施相比，测试顺序被认为合适的可能性更大。主要目标的证据强度被评为中等，但由于偏见的风险，适当性结果非常低。调查结果不一致，间接性,和不精确。
结论：AF干预措施与适度减少总DI排序相关，表明房颤的一些好处。个别研究记录了AF对图像顺序适当性的影响，范围从不显著的恶化趋势到非常显著的改善。但荟萃分析的加权平均效应大小在统计学上不显著,且确定性非常低.
方法：使用MEDLINE确定研究，EMBASE,CINAHL,12月22日，Cochrane中央对照试验登记册和ClinicalTrials.gov注册表，2022年。如果研究是随机对照试验(RCTs)，有针对性的医疗保健专业人员，并研究了房颤作为唯一干预或多方面干预的核心组成部分。使用Cochrane偏差风险工具评估每个研究的偏差风险。使用RevMan软件完成荟萃分析，并在森林地块上显示结果。
结果：纳入了11个纳入4311名临床医生或实践的RCTs。AF干预导致每1000名患者的图像测试顺序比对照干预少1.5次（差异为-2.6至-0.4的95％置信区间（CI），p值=0.009）。房颤对适宜性的影响无统计学意义，3.2%(95%CI-1.5至7.7%，p值=0.18）房颤与对照干预措施相比，测试顺序被认为合适的可能性更大。主要目标的证据强度被评为中等，但由于偏见的风险，适当性结果非常低。调查结果不一致，间接性,和不精确。
结论：AF干预措施与适度减少总DI排序相关，表明房颤的一些好处。个别研究记录了AF对图像顺序适当性的影响，范围从不显著的恶化趋势到非常显著的改善。但荟萃分析的加权平均效应大小在统计学上不显著,且确定性非常低.
