Audit and feedback to change diagnostic image ordering practices: A systematic review and meta-analysis

Area of Science:

• Health Services Research
• Medical Informatics
• Evidence-Based Medicine

Background:

• Unnecessary diagnostic imaging (DI) tests account for up to 30% of procedures, increasing healthcare costs and patient risk.
• Audit and feedback (AF) is a strategy to influence healthcare provider behavior regarding test ordering.

Purpose of the Study:

• To systematically review the effect of audit and feedback (AF) interventions on reducing diagnostic imaging (DI) test orders.
• To assess the impact of AF on the appropriateness of DI ordering.

Main Methods:

• Systematic review and meta-analysis of randomized control trials (RCTs) identified through major databases.
• Eleven RCTs involving 4311 clinicians or practices were included.
• Risk of bias was assessed using the Cochrane risk of bias tool.

Main Results:

• AF interventions led to a statistically significant reduction of 1.5 image test orders per 1000 patients (p=0.009).
• The effect of AF on the appropriateness of DI ordering was not statistically significant (p=0.18).
• Strength of evidence was moderate for reduced ordering and very low for appropriateness.

Conclusions:

• Audit and feedback interventions are associated with a modest, moderate-certainty reduction in total diagnostic imaging orders.
• The effect of AF on the appropriateness of imaging orders is uncertain, with highly variable results across studies and very low certainty.