title: Implementing a hospital guideline on pneumonia: a semi-quantitative review.
abstract: OBJECTIVE
  To quantify the impact of different guideline implementation interventions to improve treatment of community-acquired pneumonia (CAP) in a hospital setting.
  
  
  METHODS
  Pubmed, the Cochrane Library, the Cochrane Effective Practice and Organization of Care specialized register, EMBASE and CINAHL.
  
  
  METHODS
  Hospital-based trials studying the effect of guidelines on compliance with care processes, clinical and/or economic outcomes in the treatment of CAP together with a description of their implementation interventions.
  
  
  METHODS
  Two independent reviewers extracted and categorized utilized implementation interventions, assessed intensity of use and calculated changes for process of care variables, clinical and economical outcomes. Correlations between interventions and improvement of outcomes were assessed by means of Spearman's rho-test and Mann-Whitney U-test.
  
  
  RESULTS
  In 27 included studies, educational meetings (21/27) and distribution of written material (14/27) were the two most used interventions. Most individual studies show positive overall results, but taken together, no significant relation between number or type of implementation interventions and improvement of outcomes could be detected. Only audit and feedback showed a significant negative influence on the improvement rate of length of stay (p = 0.003; n = 20).
  
  
  CONCLUSIONS
  Other hospital-specific factors are likely to have a higher impact on the rate of improvement than the implementation interventions alone. Describing which interventions are most successful is unlikely to be correct without taking these hospital-specific factors into account. Future research should focus on how to identify and define these factors and how to adapt the intervention to hospital-specific factors.
authors.affiliation: Research Centre for Pharmaceutical Care and Pharmaco-Economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Belgium. pieterjan.cortoos@pharm.kuleuven.be
authors.forename: Pieter-Jan
authors.initials: PJ
authors.lastname: Cortoos
authors.forename: Steven
authors.initials: S
authors.lastname: Simoens
authors.forename: Willy
authors.initials: W
authors.lastname: Peetermans
authors.forename: Ludo
authors.initials: L
authors.lastname: Willems
authors.forename: Gert
authors.initials: G
authors.lastname: Laekeman
mesh_terms: D017714:Community-Acquired Infections / Q000628:therapy; D019091:Critical Pathways / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D007318:Inservice Training; D011014:Pneumonia / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods