Chest
Translating Guidelines Into Practice: Implementation and Physician Behavior ChangeEvidence for the Effectiveness of Techniques To Change Physician Behavior
Section snippets
The Rise (and Fall?) of Guideline Implementation Within Quality Improvement Programs
There has long been a clamor for an understanding of what works and what does not work to improve physician performance, as part of overall health-quality improvement.1234 The use of guidelines has become a popular, integral part of a reasoned approach to improving individual physician performance. A MEDLINE search lists 4,127 publications since 1966 under the publication category practice guideline, 3,969 of which were published since 1989. However, efforts to implement guidelines using tools
An Evidence-Based Approach to Review of Trials of Physician Behavior Change
Finding and employing methods to improve physician performance by changing physician behavior can be considered analogous to finding and employing drugs or other therapy to treat disease. The evidence-based medicine movement strongly asserts that randomized trials be accepted as the strongest evidence of the best therapy for a given disease. However, investigators evaluating interventions to improve individual physician performance have not held as rigorous a standard. Many studies used
Results and Discussions
Table 2 summarizes the findings of this review. A review of reviews by Bero44 is perhaps the most comprehensive single publication to date of the results of trials of physician performance improvement. A general review of all strategies to translate guidelines into practice by Davis and Taylor-Vaisey45 found that the likelihood of adoption of guidelines was influenced by several factors: qualities of the guidelines, characteristics of the health-care professional, characteristics of the
Conclusion
The reviews point to a few conclusions, but raise many questions, about the effectiveness of guideline implementation methods. Education in small doses (days) is ineffective, likely because it pales in comparison with the prior 20 years of education physicians have already received. Guideline dissemination is too passive to effect behavior change without active implementation strategies. Multiple implementation tools are more effective than single ones. Reminders may have the best evidence of
References (67)
- et al.
Implementing total quality management in health care
Jt Comm J Qual Improv
(1995) - et al.
A model of physicians' practice attributes determination
J Health Econ
(1983) - et al.
Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations
Lancet
(1993) - et al.
Performance-based physician reimbursement and influenza immunization rates in the elderly: Primary-Care Physicians of Monroe County
Am J Prev Med
(1998) - et al.
Cost containment and changing physicians' practice behavior: can the fox learn to guard the chicken coop?
JAMA
(1981) Physician utilization: the state of research about physicians' practice patterns
Med Care
(1985)- et al.
A critical appraisal of the efficacy of continuing medical education
JAMA
(1984) - et al.
Changing physicians' practices
N Engl J Med
(1993) - et al.
You can lead a horse to water: improving physicians' knowledge of probabilities may not affect their decisions
Med Decis Making
(1995) - et al.
Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians
N Engl J Med
(1989)
A controlled trial to improve care for seriously ill hospitalized patients: the study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT)
JAMA
National Guideline Clearinghouse [online]
Barriers between guidelines and improved patient care: an analysis of AHCPR's Unstable Angina Clinical Practice Guideline; Agency for Health Care Policy and Research
Health Serv Res
Effects of the National Institutes of Health Consensus Development Program on physician practice
JAMA
Users' Guides to the Medical Literature: XVIII; How to use an article evaluating the clinical impact of a computer-based clinical decision support system
JAMA
Evidence-based medicine: a new approach to teaching the practice of medicine
JAMA
Evidence-based care, 1: Setting priorities; how important is the problem? Evidence-Based Care Resource Group
Can Med Assoc J
Evidence-based care, 2: Setting guidelines; how should we manage this problem? Evidence-Based Care Resource Group
Can Med Assoc J
Evidence-based care, 3: Measuring performance; how are we managing this problem? Evidence-Based Care Resource Group
Can Med Assoc J
Evidence-based care, 4: Improving performance; how can we improve the way we manage this problem? Evidence-Based Care Resource Group
Can Med Assoc J
Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines
BMJ
Clinical guidelines: developing guidelines
BMJ
Sickle cell disease: screening, diagnosis, management, and counseling in newborns and infants; clinical practice guideline No. 6
The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline
JAMA
ABIM Subcommittee on Clinical Competence in Women's Health: what internists need to know; core competencies in women's health
Am J Med
Methods for evaluating the clinical competence of residents in internal medicine: a review
Ann Intern Med
A systems model of clinical preventive care: an analysis of factors influencing patient and physician
Health Educ Q
Beliefs and evidence in changing clinical practice
BMJ
Competence
Principles of educational outreach ('academic detailing') to improve clinical decision making
JAMA
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