title: Effectiveness of implementation strategies in improving physician adherence to guideline recommendations in heart failure: a systematic review protocol.
abstract: BACKGROUND
  The uptake of Clinical Practice Guideline (CPG) recommendations that improve outcomes in heart failure (HF) remains suboptimal. We will conduct a systematic review to identify implementation strategies that improve physician adherence to class I recommendations, those with clear evidence that benefits outweigh the risks. We will use American, Canadian and European HF guidelines as our reference.
  
  
  METHODS
  We will conduct a literature search in the databases of MEDLINE, EMBASE, HEALTHSTAR, CINAHL, Cochrane Library, Campbell Collaboration, Joanna Briggs Institute Evidence Based Practice, Centre for Reviews and Dissemination and Evidence Based Practice Centres. We will include prospective studies evaluating implementation interventions aimed at improving uptake of class I CPG recommendations in HF. We will extract data in duplicate. We will classify interventions according to their level of application (ie, provider, organisation, systems level) and common underlying characteristics (eg, education, decision-support, financial incentives) using the Cochrane Effective Practice and Organisation of Care Taxonomy. We will assess the impact of the intervention on adherence to the CPGs. Outcomes will include proportion of eligible patients who were: prescribed a CPG-recommended pharmacological treatment; referred for device consideration; provided self-care education at discharge; and provided left ventricular function assessment. We will include clinical outcomes such as hospitalisations, readmissions and mortality, if data is available. We will identify the common elements of successful and failing interventions, and examine the context in which they were applied, using the Process Redesign contextual framework. We will synthesise the results narratively and, if appropriate, will pool results for meta-analysis.
  
  
  CONCLUSIONS
  In this review, we will assess the impact of implementation strategies and contextual factors on physician adherence to HF CPGs. We will explore why some interventions may succeed in one setting and fail in another. We will disseminate our findings through briefing reports, publications and presentations.
  
  
  BACKGROUND
  CRD42015017155.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada Population Health Research Institute, Hamilton, Ontario, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Harriette G C
authors.initials: HG
authors.lastname: Van Spall
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Deepti
authors.initials: D
authors.lastname: Shanbhag
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Gabizon
authors.affiliation: Population Health Research Institute, Hamilton, Ontario, Canada.
authors.forename: Quazi
authors.initials: Q
authors.lastname: Ibrahim
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.affiliation: Department of Business and Administration, University of Winnipeg, Winnipeg, Manitoba, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Harlos
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: R Brian
authors.initials: RB
authors.lastname: Haynes
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada Population Health Research Institute, Hamilton, Ontario, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Connolly
mesh_terms: D019983:Guideline Adherence / Q000592:standards*; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D017410:Practice Guidelines as Topic; D012107:Research Design; D012648:Self Care; D000078202:Systematic Reviews as Topic; D016896:Treatment Outcome; D016276:Ventricular Function
keywords: implementation science; knowledge translation