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Diabetes Management and Education · Review
Implementation Science · August 19, 2026
Well-designed and adequately powered for the question it asks.
This systematic review and meta-analysis of 41 RCTs demonstrates that audit & feedback interventions significantly improve clinical guideline adherence among hospital-based medical specialists, with pooled odds ratios of 1.30 (95% CI 1.12–1.50) versus no intervention and 1.60 (95% CI 1.38–1.84) versus other interventions. However, substantial within-study variation and inconsistent reporting of design characteristics and contextual factors prevent definitive identification of which specific features drive effectiveness.
Systematic review and meta-analysis of randomized controlled trials. Randomized controlled trials of A&F interventions targeting clinical guideline adherence among hospital-based medical specialists. Intervention: Audit & Feedback (A&F) interventions targeting clinical guideline adherence. Compared with: No intervention (N=15 studies), another intervention (N=8 studies), or different A&F variants (N=20 studies). Not specified; studies spanned multiple countries and settings.
A&F vs. no intervention: pooled OR 1.30 (95% CI 1.12–1.50, I² = 57.8%, N = 17 comparisons) A&F vs. another intervention: pooled OR 1.60 (95% CI 1.38–1.84, I² = 8.6%, N = 8 comparisons) 41 studies included across 23 medical specialties; 6 studies with low risk of bias, 19 with some risk, 16 with high risk
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians and organizations considering A&F interventions can be reasonably confident that such interventions improve guideline adherence in specialist hospital settings. However, the substantial within-study variation and limited guidance on which design features are most effective suggest that implementation should be tailored to local context and specific clinical topics.
Systematic review and meta-analysis of 41 RCTs with pooled odds ratios showing significant improvement in guideline adherence; limited heterogeneity supports generalizability, though within-study variation and reporting gaps prevent identification of specific effective design features.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and organizations considering A&F interventions can be reasonably confident that such interventions improve guideline adherence in specialist hospital settings. However, the substantial within-study variation and limited guidance on which design features are most effective suggest that implementation should be tailored to local context and specific clinical topics.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Audit & Feedback (A&F) is a common intervention to enhance clinical guideline adherence, yet uncertainty remains regarding the factors influencing its effectiveness. To examine the effectiveness of A&F interventions targeting clinical guideline adherence of hospital-based medical specialists in general and to determine which design characteristics, co-interventions and contextual factors explain variance in A&F effectiveness. A systematic review and meta-analysis of randomized controlled trials was conducted following the Cochrane Handbook methodology. The electronic databases MEDLINE, Embase and Web of Science were searched up to January 2024. Two reviewers independently screened articles and selected studies on A&F interventions targeting clinical guideline adherence of hospital-based medical specialists. Risk of bias was assessed by two independent reviewers, following the ROB2 tools. Data on design characteristics, co-interventions, contextual factors and outcomes were extracted by one reviewer and checked by a second reviewer. Results were described descriptively and when appropriate meta-analysis and subgroup analyses using random effects modelling was performed. Forty-one studies were included. Studies had a 2-armed ( N = 35), 3-armed ( N = 5) or 2 × 2 ( N = 1) design and compared A&F vs. no intervention ( N = 15), A&F vs. another intervention ( N = 8) or A&F vs. A&F ( N = 20). Studies targeted 23 different medical specialties, of which Cardiology ( N = 8), General Medicine ( N = 7), ICU ( N = 6) and Emergency Care ( N = 6) were most targeted. Risk of bias was low in six studies, with some risk in 19 studies and high risk in 16 studies. Meta-analysis showed a significant improvement of clinical guideline adherence due to A&F, with a pooled OR of 1.30 (95% CI of 1.12–1.50), I 2 = 57.8%, N = 17 comparisons) for A&F vs. no intervention and 1.60 (95% CI 1.38–1.84, I 2 = 8.6%, N = 8 comparisons) for A&F vs. another intervention. Studies examining the effectiveness of A&F interventions showed similar effect sizes, while the variation across studies in types of design characteristics, co-interventions and context was large. Subgroup analyses for design characteristics only showed significant differences if one high risk study was included. Large variation in co-interventions and poor reporting of context factors precluded further subgroup analyses. Within studies there was large variation in effect sizes between different guideline indicators and between different hospitals. A&F showed a positive effect on clinical guideline adherence in medical specialist care, with limited heterogeneity in A&F effectiveness across different studies. Notably, this is the first A&F review to document the within-study variation in A&F effectiveness, emphasizing the influence of clinical topics and context. Furthermore, this review highlights the variability in co-interventions used alongside A&F, underscoring challenges in comparing A&F trials. PROSPERO CRD42021267983.
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