A multicenter cluster randomized controlled trial of strategies to improve thyroid function testing.
OBJECTIVE
This project aimed to compare the independent and combined effectiveness of two implementation interventions of guidelines for ordering thyroid function tests: a Memorandum Pocket Card (MPC) and a Test Request Form (TRF).


METHODS
Intervention groups were wards. The study used an experimental 2*2 factorial design with matching hospitals according to size and activity and wards according to preintervention appropriateness for test ordering. Four ward groups were established: the dual intervention group, the order form group, the pocket card group and the control group. Physicians in all groups received guidelines and were invited to a local information meeting.


METHODS
The main outcome measure of effectiveness was the Guideline Conformity Rate (GCR).


RESULTS
Six hospitals participated in the study (two middle-sized hospitals, two small-sized hospitals and two psychiatric hospitals). A total of 1412 orders for thyroid function tests were collected. GCR was 78% in the dual intervention group, 83% in the order form group, 73% in the pocket card group and 62% in the control group. The interaction between TRF and MPC was not significant (beta = -0.70; P = 0.21). Compared with simple information, TRF was effective in increasing GCR (OR, 2.65; 95% CI, 1.52-4.62), unlike MPC (OR, 1.28; CI, 0.75-2.19).


CONCLUSIONS
Using a robust design, our study shows the greater effectiveness of TRF than MPC and their association in implementing thyroid function test guidelines.
Daucourt
Valentin
V
Comité de Coordination pour l'Evaluation Clinique et la Qualité en Aquitaine, Hôpital Xavier Arnozan, Pessac, France. valentin.daucourt@ccecqa.asso.fr
Saillour-Glénisson
Florence
F
Michel
Philippe
P
Jutand
Marthe-Aline
MA
Abouelfath
Abdelilah
A
D000328:Adult; D000368:Aged; D005246:Feedback; D005260:Female; D005568:Forms and Records Control; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006753:Hospital Records; D006779:Hospitals, Public / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010362:Patients' Rooms / Q000592:standards; D017410:Practice Guidelines as Topic; D013960:Thyroid Function Tests / Q000592:standards* / Q000706:statistics & numerical data; D017749:Total Quality Management / Q000379:methods*; D019564:Unnecessary Procedures