title: Implementing guidelines in nursing homes: a systematic review.
abstract: Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes.
  
  
  
  A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE.
  
  
  
  Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE.
  
  
  
  Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes.
  
  
  
  PROSPERO 2014: CRD42014007664.
authors.affiliation: Centre for Evidence-Based Practice, Bergen University College, Inndalsveien 58, 5063, Bergen, Norway. htd@fritha.org.
authors.forename: Heinz
authors.initials: H
authors.lastname: Diehl
authors.affiliation: Centre for Evidence-Based Practice, Bergen University College, Inndalsveien 58, 5063, Bergen, Norway.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Graverholt
authors.affiliation: Centre for Evidence-Based Practice, Bergen University College, Inndalsveien 58, 5063, Bergen, Norway.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Espehaug
authors.affiliation: Centre for Evidence-Based Practice, Bergen University College, Inndalsveien 58, 5063, Bergen, Norway.|Department of Sports Science and Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Lund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D009735:Nursing Homes / Q000592:standards*; D063868:Patient Outcome Assessment; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D057170:Translational Research, Biomedical
keywords: Guideline implementation; Knowledge translation; Nursing homes; Systematic review