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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