Fowler 2007.

Methods	STUDY DESIGN: ITS Risk of Bias: MEDIUM
Participants	PROVIDERS: physicians in the hospital PARTICIPANTS: patients 80 years and older CLINICAL PROBLEM: Clostridium difficile infection in the elderly SETTING: 3 acute medical wards for the elderly in 1 university hospital in the UK
Interventions	FORMAT: Interventions: audit and feedback, dissemination of guideline; reminders (physical, laminated pocket version of guideline) Intervention Functions: education, enablement, environmental restructuring DELIVERER: AMT COMPARISON: usual care DESIRED CHANGE: reduce inappropriate
Outcomes	PRESCRIBING: Choice: monthly use of target antibiotics MICROBIAL: monthly count of cases of CDI
Notes	FINANCIAL SUPPORT: no funding. Competing Interests: none declared ADDITIONAL DATA: email response from authors but no additional data Microbial Risk of Bias LOW: Planned intervention: Low Case definition: Low, National definition. Other infection control measures: Low
Risk of bias
Bias	Authors' judgement	Support for judgement
Intervention independent (ITS) ?	High risk	Ongoing audit and feedback
Analysed appropriately (ITS) ?	Low risk	Re‐analysed
Shape of effect pre‐specified (ITS) ?	Low risk	Done. Point of analysis is point of the intervention.
Unlikely to affect data collection (ITS) ?	Low risk	Done, data were from routine systems and unlikely to change over study period.
Knowledge of the allocation adequately prevented(ITS)?	High risk	No, not possible
Incomplete outcome data addressed (ITS) ?	Low risk	Done, data were from routine systems so unlikely to be incomplete.
Free of selected reporting (ITS) ?	Low risk	Done, Figures 3 and 4
Free of other bias (ITS) ?	Low risk	> 1 year data pre‐ and postintervention