Guideline attribute and implementation preferences among physicians in multiple health systems.
OBJECTIVE
Although practice guidelines are effective in assisting providers with clinical decision making, ineffective implementation strategies often prevent their use in practice. This study aimed to understand physician preferences for guideline format, placement, content, evidence, and learning strategies in different clinical environments.


METHODS
Semistructured telephone interviews were conducted with 500 randomly selected physicians from 4 major US health systems who were involved in the treatment of patients with acute myocardial infarction or pediatric asthma. Paired sample t tests and Tukey's method of comparisons determined the relative ranking of physicians' guideline implementation preferences.


RESULTS
Physicians preferred guidelines located on the front of the patient chart, in palm pilots, or in progress notes and presented as flow charts/flow diagrams, algorithms, or preprinted orders that contain strategies to minimize readmits/encourage self-management and immediate treatment flows. Discussions with colleagues and continuing medical education are the most effective strategies for encouraging guideline use, and randomized controlled trials remain the most persuasive medical evidence.


CONCLUSIONS
Health care organizations must align guideline implementation efforts with physician preferences to encourage utilization. The results of this study reveal systematic physician preferences for guideline implementation that can be applied to clinical settings to encourage guideline use by physicians.
Stone
Tamara T
TT
Department of Health Management & Informatics, University of Missouri--Columbia, 65211, USA. StoneT@health.missouri.edu
Schweikhart
Sharon B
SB
Mantese
Annamarie
A
Sonnad
Seema S
SS
D001249:Asthma / Q000628:therapy; D001291:Attitude of Health Personnel; D002309:Cardiology / Q000193:education / Q000592:standards; D002983:Clinical Competence; D003657:Decision Making; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000193:education / Q000592:standards; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000592:standards; D009203:Myocardial Infarction / Q000628:therapy; D010372:Pediatrics / Q000193:education / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires / Q000592:standards; D014481:United States