Patient or population: Healthcare professionals (physicians, nurses and dentists) Settings: Ambulatory and hospital care in USA, Canada, UK, France, Switzerland, Taiwan, Australia, Germany, Hong Kong, India, Israel, Spain and Thailand Intervention: Manual paper reminders added to other QI intervention (feedback, patient reminders, educational meetings, educational materials, test request forms) Comparison: other QI intervention ((feedback, patient reminders, educational meetings, educational materials, test request forms)
Quality assessment							Effect	Certainty of the evidence (GRADE)	Importance
Number of studies	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations
Professional practice: dichotomous process adherence outcomes
12 studies	7 cluster‐randomised trials, 5 individually‐randomised trials	Serious limitations (−1)	Some inconsistency (−0.5)	No serious indirectness	Some imprecision (−0.5)	None	Median improvement (IQR): 4.2% (IQR −1.1% to 5.5%)	⊕⊕⊝⊝ low	IMPORTANT
Professional practice: continuous outcomes
2 studies	1 cluster‐randomised trial, 1 individually‐randomised trial	No serious limitations	No serious inconsistency	No serious indirectness	Serious imprecision (−1)	None	Median standardised mean difference (IQR): 0.28 (0.04 to 0.51)	⊕⊕⊕⊝ moderate	IMPORTANT
Patient outcomes: dichotomous
2 studies	1 cluster‐randomised trial, 1 individually‐randomised trial	No serious limitations	Serious inconsistency (−1)	No serious indirectness	Serious imprecision (−1)	None	Median improvement (IQR): −3.2% (−8.5% to 2.2%)	⊕⊕⊝⊝ low	CRITICAL
Patient outcomes: continuous
1 study	1 individually‐randomised trial	No serious limitations	Not applicable	No serious indirectness	Serious imprecision	None	Median standardised mean difference (IQR): 0.001 (−0.003 to 0.003)	⊕⊕⊕⊝ moderate	CRITICAL
Adverse effects
‐	‐	‐	‐	‐	‐	‐	Not reported	‐	IMPORTANT
Resource use
2 studies	1 cluster‐randomised trial, 1 individually‐randomised trial	No serious	No serious inconsistency	Serious indirectness (−1)	Serious imprecision (−1)	None	Additional health service costs of GBP 30 and between EUR 16.5 and EUR 67	⊕⊕⊝⊝ low	IMPORTANT
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.