Table 2 Characteristic of included studies

Durieux et al. (2003) [38]

Interrupted time series

France

An academic medical center

Patients with GI tumors

The number of tumor markers ordered by physicians and the number of admissions

Inappropriate ordering of three tumor markers (carcinoembryonic antigen, alpha-fetoprotein, carbohydrate antigen 19-9)

To evaluate the long-term impact of an intervention designed to reduce the ordering of three tumor markers frequently prescribed for gastroenterological diseases (carcinoembryonic antigen, alpha-fetoprotein, carbohydrate antigen 19-9).

Miller et al. (2011) [43]

Before and after study

USA

Multi-site urology practices

Patients with prostate cancer

Use of bone scans and computerized tomography across prostate cancer risk strata

Imaging in patients with low-risk prostate cancer

To describe findings from a Urological Surgery Quality Collaborative project focused on improving the use of radiographic staging in men with newly diagnosed prostate cancer.

Butler et al. (2015) [37]

Before and after study

UK

An academic medical center

Patients with hematologic cancers

The proportion of noncompliant transfusions received above the recommended triggers. The total number of RBCs and PLTs received during the study period, proportion of patients transfused, mean pretransfusion Hb level and PLT count, mean post-transfusion Hb level and PLT count, and time delay between pre- and post-transfusion full blood count and the receipt of blood products.

Unnecessary blood transfusion

To assess the impact of a clinical decision support system for blood product ordering in patients with hematologic disease.

Ross et al. (2015) [39]

Before and after study

USA

Urology practices

Patients with prostate cancer

The number of bone scan and CT scans

Imaging in patients with low-risk prostate cancer

To determine whether collaborative-wide data review and performance feedback would decrease the imaging rate in men with low-risk prostate cancer.

Shelton et al. (2015) [40]

Interrupted time series

USA

Outpatient clinics, academic and ambulatory care centers (VA Medical Centers)

Patients with prostate cancer

Monthly PSA-based prostate cancer screening rate in unique patients who had a visit to any primary care clinic.

PSA-based screening for prostate cancer in men aged 75 years and older

To determine whether a highly specific computerized clinical decision support alert to remind providers, at the moment of PSA screening order entry, of the current guidelines and institutional policy would reduce the use of inappropriate PSA-based prostate cancer screening among men aged 75 and over.

Martin Goodman et al. (2016) [42]

Before and after study

USA

A comprehensive cancer center

Patients with non–small-cell lung cancer

Patients with non–small-cell lung cancer who received pegylated granulocyte colony-stimulating factor (pGCSF) for low- or intermediate-risk febrile neutropenia chemotherapy regimens

Inappropriate use of prophylactic pegylated granulocyte colony-stimulating factor in patients with less than 10% risk of neutropenic fever

To examine the baseline rate of primary prophylactic pGCSF administration for patients with non–small-cell lung cancer, increase provider awareness of appropriate pGCSF use, and minimize the prescription of primary prophylactic pGCSF for patients with lung cancer who are treated with low-risk chemotherapy regimens, without a negative impact on patient safety.

Sheridan et al. (2016) [32]

Randomized clinical trial

USA

Community-based practices

Patients with prostate or colorectal cancer

The change in intention to accept screening. General and disease-specific knowledge, perceived risk and consequences of disease, screening attitudes, perceived net benefit of screening, values clarity, and self-efficacy for screening.

Prostate cancer screening in men ages 50–69 years and colorectal cancer screening in men and women ages 76–85 years

To examine the comparative effectiveness of 4 alternate formats for presenting benefits and harms information in reducing intentions for screening and changing secondary behavioral and decision-making outcomes for patients eligible for 1 of 3 low-value or potentially low-value screening services.

Hill et al. (2018) [33]

Before and after study

USA

A comprehensive interdisciplinary breast center

Patients with breast cancer

Frequency of ordering CBC and LFTs (overall and per provider), subsequent testing prompted by abnormal results, and overall compliance with guidelines.

Ordering complete blood cell count and liver function tests in patients with early breast cancer

To measure compliance with guidelines for ordering complete blood cell count (CBC) and liver function tests (LFT) before and after the calendar date when the guidelines transitioned from routine to unnecessary.

Gob et al. (2019) [41]

Before and after study

UK

A tertiary care unit

Patients admitted to oncology unit

The percentage of one-unit red cell transfusion orders (aggregated monthly).

Two-unit red cell transfusion orders.

Assess the proportion of one-unit red cell transfusion orders on the oncology ward

Hoque et al. (2020) [36]

Observational cohort study

USA

VA Medical Centers

Patients with colorectal, breast and non-small cell lung cancer

Erythropoisis stimulating agent treatment use and transfusion, and venous thromboembolism occurrence and mortality

ESA treatment use and transfusion

Evaluate the influence of FDA black box warnings and risk evaluation monitoring strategies on use of erythropoiesis stimulating agent in Veterans Administration cancer patients with chemotherapy induced anemia.

Ciprut et al. (2020) [35]

Before and after study

USA

VA Medical Center

Patients with prostate cancer

Effectiveness (number of imaging) and acceptability of an EMR-based Clinical Reminder Order Check intervention

Imaging in patients with low-risk prostate cancer

To understand how to potentially improve inappropriate prostate cancer imaging rates.

Laan et al. (2020) [34]

Interrupted time series

Holland

University and general hospitals

Patients admitted to oncology unit

Percentages of short peripheral intravenous catheters, catheter-related infections and other complications, catheter reinsertion rate, use of antibiotics, hospital length of stay (and ICU), and mortality

Inappropriate use of peripheral intravenous and urinary catheters

To reduce inappropriate use of catheters to reduce health care-associated infections.