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Table 2 Characteristics of the reviews included for governance and accountability

From: Evidence from district level inputs to improve quality of care for maternal and newborn health: interventions and findings

Reviews (n=14)

Description of included interventions

Type of studies included (number)

Targeted health care providers

Outcome reported

Pooled data (Y/N)

Results

    

Other outcomes

MNH specific outcomes

  

Bordley 2000[22]

Audit and feedback was defined as any summary of clinical performance gathered over a defined period of time and presented to the health care provider after collection.

ITS: 6

RCT: 5

Pre-post: 4

Health care professionals

 

Immunization rate

No

17% absolute decrease to 49% increase

Grimshaw 2004[23]

Audit and feedback: any summary of clinical performance of healthcare over a specified period.

C-RCTs: 110

P-RCTs: 29

C-CCTs: 7

PCCT: 10

CBAs: 40

ITS: 39

Health care professionals

Performance improvement

 

No

Absolute improvement +7.0% (range +1.3 to +16.0%) (dichot process measures)

Hulschur 2001[24]

Feedback: provision of a summary of clinical performance after the performance concerned, based on medical records, computerized data-bases or other sources of information.

55 studies:

RCTs:37

nRCTs:18

Primary care professionals directly accessible to patients for all types of health problems in US

Preventive services

 

No

Absolute increase of 3% to 26%

       

0.8 more visits

Ivers 2012[35]

Audit and feedback defined as any summary of clinical performance over a specified period of time

RCT: 49

Health care provider (excluding students)

Compliance

 

Yes

4.3% absolute increase in healthcare professionals’compliance with desired practice (dichot)

       

1.3% absolute increase in healthcare professionals’compliance with desired practice (cont)

Jamtvedt 2006[25]

Audit and feedback defined as any summary of clinical performance over a specified period of time

RCT: 118

Health care provider (excluding students)

Compliance

 

No

median-adjusted risk difference was 5% (range 3–11) (dichot)

       

median-adjusted percentage change relative to control was 16% (5–37)

Jepson 2000[26]

Audit and feedback to physicians on their performance, and sometimes that of their peers

05 studies:

RCTs: 02

quasi-RCT:01

Controlled trials: 02

All people eligible to participate in a screening programs as defined by the entry criteria for that programs, included population groups such as pregnant women, neonates, children and adults in US

 

Screening Uptake

No

One trial: no effect on screening for occult blood

       

One trial and one quasi: feedback more effective on some tests

       

Two trials: increased uptake of mammograms (p<0.05)

Johnston 2000[27]

Clinical and Medical Audit mechanisms

Total Studies: 93

All health professionals, mostly in UK

Clinician's perceptions of benefits and disadvantages of audit.

 

No

Narrative

    

Barriers and facilitators of audits.

   

Oxman 1995[28]

Audit and feedback: Any summary of clinical performance of health care over a specified period, with or without recommendations for clinical action.

Total: 31

Health care provider (excluding students) in mixed country setting

Rate of prescription for generic drugs

 

No

40% increase in rate of prescription

Pattinson 2005[29]

Any form of audit and feedback with any other clearly defined form of audit or feedback or control group

No studies

Maternity units

Time and costs

Perinatal and maternal mortality and morbidity rates

No

No studies found

    

Conflicts

   

Phillips 2010[30]

Clinical governance is a systematic and integrated approach for ensuring services is accountable for delivering quality health care. Clinical governance is delivered through a combination of strategies including: ensuring clinical competence, clinical audit, patient involvement, education and training, risk management, use of information, and staff management.

RCTs: 7, longitudinal observational: 11

Case study: 1

Primary health care providers in HIC

Process measures

 

No

Narrative

    

Outcome measures

   

Pyone 2012[31]

Not clearly defined

Total: 2

Staff, obstetricians and community

 

Maternal mortality and CFR

No

Narrative

Scott 2009[32]

Clinical governance defined as Systematic coordination and promotion of activities that contribute to continuous improvement of quality of care: clinical audit; clinical risk management; patient/service user involvement; professional education and development; clinical effectiveness research and development; staff focus; use of information systems; and institutional clinical governance committees. Separate definition of audit and feedback not given.

Total: 118

General Physicians, mostly in HIC

Compliance

 

No

Median increase in compliance 5% (dichot) and 16% for continuous

    

Patient health outcomes

   

Veer 2010[33]

Medical registry defined as a systematic and continuous collection of a defined data set for patients with specific health characteristics.

Studies:53

Health Care Professionals

Process measures

 

No

26 of 43 process measures were positively influenced

    

Outcome measures

  

5 of 36 outcome measures were positively influenced

Wensing 1998[34]

Any interventions influencing the implementation of guidelines and adoption of innovations in general practice. Feedback not defined.

Total: 143 RCTs: 39, CBA: 22, nRCTs: 13

non randomized, uncontrolled trials: 67

GPs in HIC

Guideline implementation and adoption of innovations

 

No

Effective in 10 of 15 groups