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Translating Guidelines Into Practice: Implementation and Physician Behavior ChangeEvidence for the Effectiveness of Techniques To Change Physician Behavior
Section snippets
The Rise (and Fall?) of Guideline Implementation Within Quality Improvement Programs
There has long been a clamor for an understanding of what works and what does not work to improve physician performance, as part of overall health-quality improvement.1234 The use of guidelines has become a popular, integral part of a reasoned approach to improving individual physician performance. A MEDLINE search lists 4,127 publications since 1966 under the publication category practice guideline, 3,969 of which were published since 1989. However, efforts to implement guidelines using tools
An Evidence-Based Approach to Review of Trials of Physician Behavior Change
Finding and employing methods to improve physician performance by changing physician behavior can be considered analogous to finding and employing drugs or other therapy to treat disease. The evidence-based medicine movement strongly asserts that randomized trials be accepted as the strongest evidence of the best therapy for a given disease. However, investigators evaluating interventions to improve individual physician performance have not held as rigorous a standard. Many studies used
Results and Discussions
Table 2 summarizes the findings of this review. A review of reviews by Bero44 is perhaps the most comprehensive single publication to date of the results of trials of physician performance improvement. A general review of all strategies to translate guidelines into practice by Davis and Taylor-Vaisey45 found that the likelihood of adoption of guidelines was influenced by several factors: qualities of the guidelines, characteristics of the health-care professional, characteristics of the
Conclusion
The reviews point to a few conclusions, but raise many questions, about the effectiveness of guideline implementation methods. Education in small doses (days) is ineffective, likely because it pales in comparison with the prior 20 years of education physicians have already received. Guideline dissemination is too passive to effect behavior change without active implementation strategies. Multiple implementation tools are more effective than single ones. Reminders may have the best evidence of
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