title: The effects of a randomised multi-centre trial and international accreditation on availability and quality of clinical guidelines.
abstract: OBJECTIVE
  To examine the availability and quality of clinical guidelines on perioperative diabetes care in hospital units before and after a randomised clinical trial (RCT) and international accreditation.
  
  
  METHODS
  Interventional "before-after" study in 51 units (38 surgical and 13 anaesthetic) in nine hospitals participating in a RCT in the greater Copenhagen area; 27 of the units also underwent international accreditation.
  
  
  RESULTS
  The proportion of units with guidelines increased from 24/51 (47 percent) units before to 38/51 (75 percent) units after the trial. Among the 27 units without guidelines before the trial, significantly more accredited units compared to non-accredited units had a guideline after the trial (9/10 (90 percent) compared to 5/17 (29 percent). The quality of the systematic development scale and the clinical scales improved significantly after the trial in both accredited units (both p < 0.001) and in non-accredited units (both p < 0.02). The improvement of the systematic development scale was significantly higher in accredited than in non-accredited units (p < 0.01).
  
  
  CONCLUSIONS
  The combination of conducting both the DIPOM Trial and international accreditation led to a significant improvement of both dissemination and quality of guidelines on perioperative diabetic care.
authors.affiliation: The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Anne Benedicte
authors.initials: AB
authors.lastname: Juul
authors.forename: Christian
authors.initials: C
authors.lastname: Gluud
authors.forename: Jørn
authors.initials: J
authors.lastname: Wetterslev
authors.forename: Torben
authors.initials: T
authors.lastname: Callesen
authors.forename: Gorm
authors.initials: G
authors.lastname: Jensen
authors.forename: Allan
authors.initials: A
authors.lastname: Kofoed-Enevoldsen
mesh_terms: D000068:Accreditation / Q000592:standards*; D003718:Denmark; D003920:Diabetes Mellitus; D017408:Guidelines as Topic; D006801:Humans; D038622:Internationality; D019990:Perioperative Care; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011785:Quality Assurance, Health Care