title: A multicenter cluster randomized controlled trial of strategies to improve thyroid function testing.
abstract: 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.
authors.affiliation: Comité de Coordination pour l'Evaluation Clinique et la Qualité en Aquitaine, Hôpital Xavier Arnozan, Pessac, France. valentin.daucourt@ccecqa.asso.fr
authors.forename: Valentin
authors.initials: V
authors.lastname: Daucourt
authors.forename: Florence
authors.initials: F
authors.lastname: Saillour-Glénisson
authors.forename: Philippe
authors.initials: P
authors.lastname: Michel
authors.forename: Marthe-Aline
authors.initials: MA
authors.lastname: Jutand
authors.forename: Abdelilah
authors.initials: A
authors.lastname: Abouelfath
mesh_terms: 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