Standard Template: Detailed Data Abstraction Form For LMBP Systematic Reviews

Part I. Descriptive information

Tracking Information: 1. Intervention((s)/Practice(s):2. Reviewer Name :3. Author Last Name:4. Article ID # :5. Date of Abstraction:

1. Bibliographicinformation 2. Study Description 3. Practice

Description:4. Outcome

Measures 5. Results (Effect Size)A. Short Name for StudyCitation:

O. Intervention/Alternatepractice:

S. Outcome Measure U. Sample size:

C2. Name the source of publication:

H. Study Design:

I2. Name of the facility(ies) or organization(s) where study was performed:

I3. Facility/ Organization type:

I4. Facility Size:

O1. Name of the practice/ intervention:

O2. Practice/intervention description:

Total sample sizeS1. Description of Outcome measures:

C. Published Document:C1. Document type:

B. Type of Document:

I. Facility description: I1. Location of the facility:

1. Intervention group (n):

2. Comparison group (n):

Pre-intervention implementation:

Post-intervention implementation:

Pre-intervention implementation:

Post-intervention implementation:

Standard Template: Detailed Data Abstraction Form For LMBP Systematic Reviews

D. Unpublisheddocument:D1. Document type:

D2. Permission to be identified (unpublished only):

D3. Complete Citation or Identifying Information for Unpublished Source:

D4. Date of Receipt:

Intermediate Outcomes:

Health Outcomes:

I5. Total Annual Test Volume:

I6. Setting within facility /organization where practice implemented:

J. Sample Description:J1. Sample size:

J2. Sample type:

J3.Population demographics:

V. Findings (ES): Intermediate Outcomes:

ES:

Health Outcomes:

ES:

V1. Direction of effect:

V2. Type of statistical test:

V3. Effect size significance:

O2. Practice/intervention (continued):Start Date:

End Date:

Ongoing:

Who:

How:

S1. Description of Outcome measures (continued):

Calculate if not reported in the study.

Calculate if not reported in the study.

Standard Template: Detailed Data Abstraction Form For LMBP Systematic Reviews

T. Data collectionInformation:

T1. Data collection method:

1. Baseline

2. Follow-up (FU)

T2. Data collection period:

E. Author Affiliations:

F. Funding source:

K. Specific inclusion/exclusioncriteria for sample selection:

L. Sampling strategy:

P. Practice implementationduration:

Q2. Test schedule:

Q. Information on involvedstaff and test schedule: Q1. Staff:

W. Sub group analysis:

Note: In case of multiple follow-ups:

1. FU1

2. FU2

T2. Data collection period:

Were secondary results of interest reported (including sub-population differences, or others)?

If yes, describe those results

Yes No

Standard Template: Detailed Data Abstraction Form For LMBP Systematic Reviews

G. Other references: R. Intervention descriptionto comparison group:

M. Comparison group:

N. Attrition rate:

X. Additional information:

Attrition is obvious but it is not discussed or acknowledged by author

Standard Template: Detailed Data Abstraction Form For LMBP Systematic Reviews

Part II. Evaluation of Study Quality

1. Quality Rating:(10 point maximum)

Study description (max 3pts can be deducted for limitations):

Practice description (max 2pts can be deducted for limitations):

Outcome measures (max 2pts can be deducted for limitations):

Results/findings (max 3pts can be deducted for limitations):

1 pt. for limited description of setting

1 pt. for limited description of sample characteristics

1 pt. for presence of any biases related to study description

1 pt. for limited description of practice

1 pt. for limited or no description of the comparator/comparison group

1 pt. for limited outcome measure description or validity of outcome or measure used

1 pt. for limited data collection method description

1 pt. for small sample size

1 pt. for limited or no information for statistical analysis

1 pt. for any uncontrolled deviations and Results/ Conclusions biases