title: Control mechanisms for guideline implementation.
abstract: OBJECTIVE
  One approach to reducing health care costs while ensuring high-quality patient care is the use of medical practice guidelines. This study focuses on mechanisms that facilitate the implementation of guidelines primarily intended to reduce cost without increasing patient risk, using a multiinstitutional case study of a single guideline.
  
  
  METHODS
  We conducted semistructured interviews with physicians and administrators involved with guideline implementation in 61 academic medical centers. The interviews included questions on both implementation methods and the final success of implementation at each center.
  
  
  RESULTS
  We identified 5 factors likely to be of importance to the guideline implementation process: (1) the use of a written form to routinize the process; (2) the acquisition of informed consent; (3) the presence of an active department chair (or section chief) to serve as an opinion leader; (4) the use of individual-level monitoring; and (5) the granting of financial incentives.
  
  
  CONCLUSIONS
  This study allowed the identification of four processes for guideline implementation. For hospitals contemplating implementation of guidelines aimed toward cost reduction or selective use of various agents for other purposes, a decision process to identify the control mechanism best suited to an individual institution is a crucial step toward success.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Penn 19104, USA. seema.sonnad@uphs.upenn.edu
authors.forename: Seema S
authors.initials: SS
authors.lastname: Sonnad
authors.forename: Karl
authors.initials: K
authors.lastname: Matuszewski
mesh_terms: D003363:Cost Control; D019983:Guideline Adherence / Q000458:organization & administration*; D007087:Illinois; D007407:Interviews as Topic; D009096:Multi-Institutional Systems; D019982:Organizational Case Studies; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D011872:Radiology Department, Hospital