The effectiveness of clinical guideline implementation strategies--a synthesis of systematic review findings.
OBJECTIVE
To establish the effectiveness of clinical guideline implementation strategies. Data sources/study setting Systematic reviews in full text, English language, 1987-2007, reporting any measure of clinical process change or cost-benefit analysis.


METHODS
Overview of secondary evidence


METHODS
Independent critical appraisal using AMSTAR, primary author undertaking all data extraction using a purpose-built form. Principal findings We identified 144 potential papers, from which 33 systematic reviews were included. These reflected 714 primary studies involving 22 512 clinicians, in a range of health care settings. Implementation strategies were varied, rarely comparable, with variable outcomes. Effective implementation strategies included multifaceted interventions, interactive education and clinical reminder systems. Didactic education and passive dissemination strategies were ineffective. Cost-effectiveness studies were rare.


CONCLUSIONS
Successful guideline implementation strategies should be multifaceted, and actively engage clinicians throughout the process.
Prior
Mathew
M
Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
Guerin
Michelle
M
Grimmer-Somers
Karen
K
D000465:Algorithms; D054869:Clinical Audit; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D003661:Decision Support Techniques; D004059:Diffusion of Innovation; D004496:Education, Continuing / Q000458:organization & administration; D019317:Evidence-Based Medicine / Q000193:education / Q000458:organization & administration; D019983:Guideline Adherence; D006301:Health Services Needs and Demand; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration; D017010:Reminder Systems; D012107:Research Design