Table 1 Summary of conclusions from systematic reviews of experimental studies examining specific intervention approaches to change practitioner behavior or patient outcomes

Clinical pathways [59]

Clinical pathways are associated with reduced in-hospital complications and improved documentation without negatively impacting on length of stay and hospital costs.

Organizational infrastructures [60]

Only one low-quality study.

Strategies to change organizational culture [48]

No studies that fulfilled the methodological criteria for this review.

External inspection of compliance with standards

Only two studies identified for inclusion in this review, no firm conclusions could therefore be drawn about the effectiveness of external inspection on compliance with standards.

Continuing education meetings and workshops [52]

Educational meetings, alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviors.

Educational outreach visits (EOV) [54]

EOVs alone or when combined with other interventions have effects on prescribing that are relatively consistent and small, but potentially important. Their effects on other types of professional performance vary from small to modest improvements, and it is not possible from this review to explain that variation.

Local opinion leaders [61]

Opinion leaders alone or in combination with other interventions may successfully promote evidence-based practice, but effectiveness varies both within and between studies. These results are based on heterogeneous studies differing in terms of type of intervention, setting, and outcomes measured. In most of the studies the role of the opinion leader was not clearly described, and it is therefore not possible to say what the best way is to optimize the effectiveness of opinion leaders.

Printed educational materials (PEMs) [62]

The results of this review suggest that when compared to no intervention, PEMs when used alone may have a beneficial effect on process outcomes but not on patient outcomes. Despite this wide of range of effects reported for PEMs, clinical significance of the observed effect sizes is not known. There is insufficient information about how to optimize educational materials. The effectiveness of educational materials compared to other interventions is uncertain.

Public release of performance data [63]

The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behavior or improves care. Evidence that the public release of performance data may have an impact on the behavior of healthcare professionals or organizations is lacking.

Paying for performance (LMIC) [64]

The current evidence base is too weak to draw general conclusions; more robust and also comprehensive studies are needed.

Audit and feedback [53]

Audit and feedback generally leads to small but potentially important improvements in professional practice. The effectiveness of audit and feedback seems to depend on baseline performance and how the feedback is provided. Future studies of audit and feedback should directly compare different ways of providing feedback.

Inter-professional education (IPE) [65]

This updated review found six studies that met the inclusion criteria, in contrast to our first review that found no eligible studies. Although these studies reported some positive outcomes, due to the small number of studies, the heterogeneity of interventions, and the methodological limitations, it is not possible to draw generalizable inferences about the key elements of IPE and its effectiveness.