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.