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

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

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Meta-Analysis
Guidelines
Professional Role
Controlled Clinical Trials
Inpatients
Outpatients
Randomized Controlled Trials
Odds Ratio
Regression Analysis
Learning
Controlled Before-After Studies

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The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis. / Dijkstra, Rob; Wensing, Michel; Thomas, Ruth; Akkermans, Reinier; Braspenning, Joze; Grimshaw, Jeremy; Grol, Richard.

In: BMC Health Services Research, Vol. 6, 53, 28.04.2006.

Research output: Contribution to journalArticle

Dijkstra, Rob ; Wensing, Michel ; Thomas, Ruth ; Akkermans, Reinier ; Braspenning, Joze ; Grimshaw, Jeremy ; Grol, Richard. / The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis. In: BMC Health Services Research. 2006 ; Vol. 6.
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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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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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