Results
Our primary search identified 2018 potentially eligible studies. After
removing duplicates, review articles, abstracts, editorials, and
letters, 28 full-text articles were examined. A total of 9 studies
including 22,070 subjects met eligibility criteria and were included in
our meta-analysis.3,10–17 3 studies were randomized
control trials comparing a QI intervention group to a non-intervention
group while 6 were prospective studies comparing rarely appropriate
echocardiography ordering behavior in a single study group before and
after QI intervention. The mean follow-up was 14 months. Education Tools
used in included studies were small group lectures, grand rounds,
printed educational resources, electronic AUC cards, and physical
pocket-sized AUC cards. Feedback Tools included feedback emails and
performance reports sent to providers at different intervals. Decision
Support Tools were electronic medical record pop-ups when
echocardiograms are ordered.