Does implementation of evidence-based guidelines follow the available evidence? Implementation of hypertension guidelines at Veterans Affairs medical centers.
BACKGROUND
We sought to determine whether the proportion of strategies adopted in the implementation of evidence-based clinical guidelines by Department of Veterans Affairs medical centers (VAMCs) reflects an evidence-based assessment of the implementation strategies' relative effectiveness that was widely disseminated among VAMCs.


METHODS
We used data from a multisite observational study we conducted to test a model of changing clinical behaviors. For that study, we had compiled information from key informants at 43 VAMCs about strategies for implementing the VA's new hypertension management guidelines. We had subsequently classified the reported strategies into 41 categories. For this study, we matched these 41 categories to the 8 broad categories of implementation strategies in terms of which effectiveness of strategies had been reported to VAMCs. We compared the 8 categories' rank order on effectiveness with their ranking by number of VAMCs adopting the strategies.


RESULTS
The effectiveness-based rank ordering does not correspond with rank order based on percentage of VAMCs adopting (Spearman correlation coefficient = -0.4).


CONCLUSIONS
Results suggest that institutions, like practitioners, face barriers related to knowledge, attitudes, and behavior-including, in particular, insufficient resources-that impede their following the evidence when choosing guideline implementation strategies.
Wyszewianski
Leon
L
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA. leonw@umich.edu
Kowalski
Christine
C
Lowery
Julie
J
Green
Lee A
LA
D001291:Attitude of Health Personnel; D048909:Diabetes Complications; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006787:Hospitals, Veterans / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control*; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D014481:United States; D014493:United States Department of Veterans Affairs