The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis

Rob Dijkstra; Michel Wensing; Ruth Thomas; Reinier Akkermans; Joze Braspenning; Jeremy Grimshaw; Richard Grol

doi:10.1186/1472-6963-6-53

The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis

Rob Dijkstra, Michel Wensing, Ruth Thomas, Reinier Akkermans, Joze Braspenning, Jeremy Grimshaw, Richard Grol

University of Ottawa

Research output: Contribution to journal › Article › peer-review

90 Citations (Scopus)

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Abstract

Abstract
Objective
To measure the effectiveness of strategies to implement clinical guidelines and the influence of organisational characteristics on hospital care.

Methods
Systematic review and meta regression analysis including randomised controlled trials, controlled clinical trials and controlled before-and-after studies.

Results
53 studies were identified, including 81 comparisons. The total effect of all intervention strategies appeared to be Odds ratio 2.13 (SD 1.72-2.65). Intervention strategies (such as educational material, reminders, feedback) and other professional interventions that mostly comprised revisions of professional roles were found to be relatively strong components of multi faceted interventions. Outcomes of organisational effect modifiers were better in a learning environment in inpatient studies than in outpatient studies. Interventions developed outside hospitals yielded better outcomes; OR 4.62 (SD 2.82-7.57) versus OR 1.78 (SD 1.36-2.23).

Conclusion
Both single and multifaceted interventions seemed to be effective in hospital settings. Evidence for the effects of organisational determinants remained limited.

Original language	English
Article number	53
Number of pages	10
Journal	BMC Health Services Research
Volume	6
DOIs	https://doi.org/10.1186/1472-6963-6-53
Publication status	Published - 28 Apr 2006

Bibliographical note

We are grateful to our colleagues involved in the systematic review of guideline dissemination and implementation strategies across all settings especially Cynthia Fraser, Graeme MacLennan, Craig Ramsay, Paula Whitty, Martin Eccles, Lloyd Matowe, Liz Shirran. The systematic review of guideline dissemination and implementation strategies across all settings was funded by the UK NHS Health Technology Assessment Program. Dr Ruth Thomas is funded by a Wellcome Training Fellowship in Health Services Research. (Grant number GR063790MA). The Health Services Research Unit is funded by the Chief Scientists Office of the Scottish Executive Department of Health. Dr Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. However the views expressed are those of the authors and not necessarily the funders.

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The relationship
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Final published version, 809 KBLicence: CC BY

Cite this

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title = "The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis",

abstract = "AbstractObjectiveTo measure the effectiveness of strategies to implement clinical guidelines and the influence of organisational characteristics on hospital care.MethodsSystematic review and meta regression analysis including randomised controlled trials, controlled clinical trials and controlled before-and-after studies.Results53 studies were identified, including 81 comparisons. The total effect of all intervention strategies appeared to be Odds ratio 2.13 (SD 1.72-2.65). Intervention strategies (such as educational material, reminders, feedback) and other professional interventions that mostly comprised revisions of professional roles were found to be relatively strong components of multi faceted interventions. Outcomes of organisational effect modifiers were better in a learning environment in inpatient studies than in outpatient studies. Interventions developed outside hospitals yielded better outcomes; OR 4.62 (SD 2.82-7.57) versus OR 1.78 (SD 1.36-2.23).ConclusionBoth single and multifaceted interventions seemed to be effective in hospital settings. Evidence for the effects of organisational determinants remained limited.",

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note = "We are grateful to our colleagues involved in the systematic review of guideline dissemination and implementation strategies across all settings especially Cynthia Fraser, Graeme MacLennan, Craig Ramsay, Paula Whitty, Martin Eccles, Lloyd Matowe, Liz Shirran. The systematic review of guideline dissemination and implementation strategies across all settings was funded by the UK NHS Health Technology Assessment Program. Dr Ruth Thomas is funded by a Wellcome Training Fellowship in Health Services Research. (Grant number GR063790MA). The Health Services Research Unit is funded by the Chief Scientists Office of the Scottish Executive Department of Health. Dr Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. However the views expressed are those of the authors and not necessarily the funders. ",

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AU - Wensing, Michel

AU - Thomas, Ruth

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AU - Braspenning, Joze

AU - Grimshaw, Jeremy

AU - Grol, Richard

N1 - We are grateful to our colleagues involved in the systematic review of guideline dissemination and implementation strategies across all settings especially Cynthia Fraser, Graeme MacLennan, Craig Ramsay, Paula Whitty, Martin Eccles, Lloyd Matowe, Liz Shirran. The systematic review of guideline dissemination and implementation strategies across all settings was funded by the UK NHS Health Technology Assessment Program. Dr Ruth Thomas is funded by a Wellcome Training Fellowship in Health Services Research. (Grant number GR063790MA). The Health Services Research Unit is funded by the Chief Scientists Office of the Scottish Executive Department of Health. Dr Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. However the views expressed are those of the authors and not necessarily the funders.

PY - 2006/4/28

Y1 - 2006/4/28

N2 - AbstractObjectiveTo measure the effectiveness of strategies to implement clinical guidelines and the influence of organisational characteristics on hospital care.MethodsSystematic review and meta regression analysis including randomised controlled trials, controlled clinical trials and controlled before-and-after studies.Results53 studies were identified, including 81 comparisons. The total effect of all intervention strategies appeared to be Odds ratio 2.13 (SD 1.72-2.65). Intervention strategies (such as educational material, reminders, feedback) and other professional interventions that mostly comprised revisions of professional roles were found to be relatively strong components of multi faceted interventions. Outcomes of organisational effect modifiers were better in a learning environment in inpatient studies than in outpatient studies. Interventions developed outside hospitals yielded better outcomes; OR 4.62 (SD 2.82-7.57) versus OR 1.78 (SD 1.36-2.23).ConclusionBoth single and multifaceted interventions seemed to be effective in hospital settings. Evidence for the effects of organisational determinants remained limited.

AB - AbstractObjectiveTo measure the effectiveness of strategies to implement clinical guidelines and the influence of organisational characteristics on hospital care.MethodsSystematic review and meta regression analysis including randomised controlled trials, controlled clinical trials and controlled before-and-after studies.Results53 studies were identified, including 81 comparisons. The total effect of all intervention strategies appeared to be Odds ratio 2.13 (SD 1.72-2.65). Intervention strategies (such as educational material, reminders, feedback) and other professional interventions that mostly comprised revisions of professional roles were found to be relatively strong components of multi faceted interventions. Outcomes of organisational effect modifiers were better in a learning environment in inpatient studies than in outpatient studies. Interventions developed outside hospitals yielded better outcomes; OR 4.62 (SD 2.82-7.57) versus OR 1.78 (SD 1.36-2.23).ConclusionBoth single and multifaceted interventions seemed to be effective in hospital settings. Evidence for the effects of organisational determinants remained limited.

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DO - 10.1186/1472-6963-6-53

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JO - BMC Health Services Research

JF - BMC Health Services Research

M1 - 53

ER -

The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis

Abstract

Bibliographical note

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