BACKGROUND Assessment of clinical variation has attracted increasing interest in health systems internationally due to growing awareness about better value and appropriate health care as a mechanism for enhancing efficient, effective and timely care. Feedback using administrative databases to provide benchmarking data has been utilised in several countries to explore clinical care variation and to enhance guideline adherent care. Whilst methods for detecting variation are well-established, methods for determining variation that is unwarranted and addressing this are strongly debated. This study aimed to synthesize published evidence of the use of feedback approaches to address unwarranted clinical variation (UCV). METHODS A rapid review and narrative evidence synthesis was undertaken as a policy-focused review to understand how feedback approaches have been applied to address UCV specifically. Key words, synonyms and subject headings were used to search the major electronic databases Medline and PubMed between 2000 and 2018. Titles and abstracts of publications were screened by two reviewers and independently checked by a third reviewer. Full text articles were screened against the eligibility criteria. Key findings were extracted and integrated in a narrative synthesis. RESULTS Feedback approaches that occurred over a duration of 1 month to 9 years to address clinical variation emerged from 27 publications with quantitative (20), theoretical/conceptual/descriptive work (4) and mixed or multi-method studies (3). Approaches ranged from presenting evidence to individuals, teams and organisations, to providing facilitated tailored feedback supported by a process of ongoing dialogue to enable change. Feedback approaches identified primarily focused on changing clinician decision-making and behaviour. Providing feedback to clinicians was identified, in a range of a settings, as associated with changes in variation such as reducing overuse of tests and treatments, reducing variations in optimal patient clinical outcomes and increasing guideline or protocol adherence. CONCLUSIONS The review findings suggest value in the use of feedback approaches to respond to clinical variation and understand when action is warranted. Evaluation of the effectiveness of particular feedback approaches is now required to determine if there is an optimal approach to create change where needed.

中文翻译：

---

反馈方法可以减少不必要的临床差异吗？系统的快速证据综合。

背景技术由于对更好的价值和适当的保健作为增强有效，有效和及时的保健的机制的认识不断提高，临床变异的评估已引起国际上对卫生系统的越来越多的关注。在几个国家/地区，使用行政数据库提供的反馈信息来提供基准数据，以探索临床护理的变化并增强指南依从性护理。尽管已经很好地建立了检测变化的方法，但是对于确定不必要的变化并解决该问题的方法的争论也很激烈。这项研究旨在综合使用反馈方法解决不必要的临床变异（UCV）的已发表证据。方法快速审查和叙述性证据综合作为一项以政策为重点的审查，旨在了解如何使用反馈方法专门解决UCV。在2000年至2018年之间，使用关键词，同义词和主题词来搜索主要的电子数据库Medline和PubMed。出版物的标题和摘要由两名审稿人筛选，并由第三名审稿人独立检查。根据资格标准筛选了全文文章。提取主要发现并将其整合到叙述性综合中。结果反馈方法在1个月至9年的时间内针对临床差异而出现，涉及27种出版物，涉及定量（20），理论/概念/描述性研究（4）以及混合或多方法研究（3）。方法的范围从向个人，团队和组织提供证据到提供方便的，量身定制的反馈，并通过持续对话以支持变更的过程来支持。确定的反馈方法主要侧重于改变临床医生的决策和行为。在一定范围内，确定了向临床医生提供反馈与变化的变化相关，例如减少对测试和治疗的过度使用，减少最佳患者临床结果的变化以及增加指南或方案的依从性。结论审查结果表明，使用反馈方法应对临床变异和了解何时需要采取行动具有价值。