title: [Audit and feedback, and continuous quality improvement strategies to improve the quality of care for type 2 diabetes: a systematic review of literature].
abstract: OBJECTIVE
  we analysed evidence on effective interventions to improve the quality of care and management in patients with diabetes type 2. This review focuses particularly on audit and feedback intervention, targeted to healthcare providers, and continuous quality improvement (CQI) involving health professionals and health care systems, respectively.
  
  
  METHODS
  we searched The Cochrane Library, PubMed, and EMBASE (search period: January 2005-December 2015) to identify systematic reviews (SR) and randomized controlled trials (RCTs) considering patients' outcomes and process measures as quality indicators in diabetes care. Selection of studies and data extraction were carried out independently by two reviewers. Methodological quality of individual studies was assessed using the checklist «Assessment of methodological quality of systematic review» (AMSTAR) and the Cochrane's tool, respectively. We produced summaries of results for each study design.
  
  
  RESULTS
  the search process resulted in 810 citations. One SR and 7 RCTs that compared any intervention in which audit and feedback and CQI was a component vs. other interventions were selected. The SR found that audit and feedback activity was associated with improvements of glycaemic (mean difference: 0.26; 95%CI 0.08;0.44) and cholesterol control (mean difference: 0.03; 95%CI -0.04;0.10). CQI interventions were not associated with an improvement of quality of diabetes care. The RCTs considered in this review compared a broad range of interventions including feedback as unique activity or as part of more complex strategies. The methodological quality was generally poor in all the included trials.
  
  
  CONCLUSIONS
  the available evidence suggests that audit and feedback and CQI improve quality of care in diabetic patients, although the effect is small and heterogeneous among process and outcomes indicators.
authors.affiliation: Dipartimento di epidemiologia, Servizio sanitario regionale, Regione Lazio, Roma.
authors.forename: Simona
authors.initials: S
authors.lastname: Vecchi
authors.affiliation: Dipartimento di epidemiologia, Servizio sanitario regionale, Regione Lazio, Roma. n.agabiti@deplazio.it.
authors.forename: Nera
authors.initials: N
authors.lastname: Agabiti
authors.affiliation: Dipartimento di epidemiologia, Servizio sanitario regionale, Regione Lazio, Roma.
authors.forename: Susanna
authors.initials: S
authors.lastname: Mitrova
authors.affiliation: Dipartimento di epidemiologia, Servizio sanitario regionale, Regione Lazio, Roma.
authors.forename: Laura
authors.initials: L
authors.lastname: Cacciani
authors.affiliation: Dipartimento di epidemiologia, Servizio sanitario regionale, Regione Lazio, Roma.
authors.forename: Laura
authors.initials: L
authors.lastname: Amato
authors.affiliation: Dipartimento di epidemiologia, Servizio sanitario regionale, Regione Lazio, Roma.
authors.forename: Marina
authors.initials: M
authors.lastname: Davoli
authors.affiliation: Dipartimento di epidemiologia, Servizio sanitario regionale, Regione Lazio, Roma.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Bargagli
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D019317:Evidence-Based Medicine; D005246:Feedback; D006801:Humans; D007558:Italy; D008485:Medical Audit; D017060:Patient Satisfaction; D058996:Quality Improvement; D011787:Quality of Health Care