Organizational interventions to encourage guideline implementation.
Evidence-based guidelines hold considerable promise for continued improvement of health-care delivery. However, the availability of clinical practice guidelines does not automatically lead to changes in practice patterns. Using a "push-pull-capacity" model, this article describes strategies to improve guideline implementation for three types of organizations: national organizations, insurer and health-care organizations, and health-care purchasers. Push strategies focus on the guideline development process and include rigorous review and meta-analysis of peer-reviewed research, and use of multidisciplinary expert teams, subjecting guidelines to peer review and comment and using measurable clinical outcomes to define guidelines. PULL: strategies focus on creating a demand for guideline implementation and include professional organization endorsement, quality measures based on guideline-related outcomes, and guideline-based performance objectives in purchaser contracts and physician compensation agreements. Capacity strategies focus on systems that facilitate guideline implementation. Example strategies are providing benefit coverage and reimbursement for guideline-based treatment protocols, and implementing clinical information systems for population-based tracking, outcomes monitoring, and benchmarking feedback.
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA. curry.s@ghc.org
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D003695:Delivery of Health Care / Q000458:organization & administration*; D019983:Guideline Adherence; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D000074606:Smoking Prevention