title: The effectiveness of clinical guideline implementation strategies--a synthesis of systematic review findings.
abstract: 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.
authors.affiliation: Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
authors.forename: Mathew
authors.initials: M
authors.lastname: Prior
authors.forename: Michelle
authors.initials: M
authors.lastname: Guerin
authors.forename: Karen
authors.initials: K
authors.lastname: Grimmer-Somers
mesh_terms: 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