The effectiveness of clinical guideline implementation strategies - a synthesis of systematic review findings

Objective  To establish the effectiveness of clinical guideline implementation strategies. Data sources/study setting  Systematic reviews in full text, English language, 1987–2007, reporting any measure of clinical process change or cost–benefit analysis. Study design  Overview of secondary evidence...

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Bibliographic Details
Published in:Journal of evaluation in clinical practice 2008-10, Vol.14 (5), p.888-897
Main Authors: Prior, Mathew, Guerin, Michelle, Grimmer-Somers, Karen
Format: Article
Language:English
Subjects:
Algorithms
Clinical Audit
clinical guideline
Clinical Protocols
compliance
cost-benefit
Cost-Benefit Analysis
Critical Pathways
Decision Support Techniques
Diffusion of Innovation
Education, Continuing - organization & administration
effectiveness
Evidence-Based Medicine - education
Evidence-Based Medicine - organization & administration
Guideline Adherence
Health Services Needs and Demand
Humans
implementation
Information Dissemination - methods
Outcome Assessment (Health Care)
Practice Guidelines as Topic - standards
Quality of Health Care - organization & administration
Reminder Systems
Research Design
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Summary:Objective  To establish the effectiveness of clinical guideline implementation strategies. Data sources/study setting  Systematic reviews in full text, English language, 1987–2007, reporting any measure of clinical process change or cost–benefit analysis. Study design  Overview of secondary evidence Data collection/extraction methods  Independent critical appraisal using AMSTAR, primary author undertaking all data extraction using a purpose‐built form. Principal findings  We identified 144 potential papers, from which 33 systematic reviews were included. These reflected 714 primary studies involving 22 512 clinicians, in a range of health care settings. Implementation strategies were varied, rarely comparable, with variable outcomes. Effective implementation strategies included multifaceted interventions, interactive education and clinical reminder systems. Didactic education and passive dissemination strategies were ineffective. Cost‐effectiveness studies were rare. Conclusions  Successful guideline implementation strategies should be multifaceted, and actively engage clinicians throughout the process.
ISSN:1356-1294
1365-2753
DOI:10.1111/j.1365-2753.2008.01014.x