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

Research output: Contribution to journalArticle

81 Citations (Scopus)
5 Downloads (Pure)

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 languageEnglish
Article number53
Number of pages10
JournalBMC Health Services Research
Volume6
DOIs
Publication statusPublished - 28 Apr 2006

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