Traditional approaches to disseminating research findings have failed to achieve optimal healthcare.
In a systematic review of 235 studies of guideline dissemination and implementation strategies, we observed the following:
there was a median 10% improvement across studies, suggesting that it is possible to change healthcare provider behaviour and improve quality of care;
most dissemination and implementation strategies resulted in small to moderate improvements in care;
multifaceted interventions did not appear more effective than single interventions.
The interpretation of our systematic review is hindered by the lack of a robust theoretical base for understanding healthcare provider and organisational behaviour.
Future research is required to develop a better theoretical base and to evaluate further guideline dissemination and implementation strategies.
- 1. Schuster M, McGlynn E, Brook RH. How good is the quality of health care in the United States? Milbank Q 1998; 76: 517-563.
- 2. Grol R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care 2001; 39(8 Suppl 2): II46-II54.
- 3. Song NS, Crowley WF, Genel M, et al. Central challenges facing the national clinical research enterprise. JAMA 2003; 289: 1278-1287.
- 4. Grol R. Beliefs and evidence in changing clinical practice. BMJ 1997; 315: 418-421.
- 5. Hanney S, Soper B, Buxton M. Evaluation of the NHS R&D Implementation Methods Programme. London: Health Economics Research Group, Brunel University, 2003.
- 6. Agency for Health Research and Quality. Translating research into practice II (TRIP II). Washington, DC: AHRQ, 2001.
- 7. Grimshaw JM, Thomas RE, MacLennan G, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004. In press.
- 8. Medical Research Council. A framework for development and evaluation of RCTs for complex interventions to improve health. London: Medical Research Council, 2000. Available at: www.mrc.ac.uk/pdf-mrc_cpr.pdf (accessed Jan 2004).
- 9. Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q 2001; 79: 281-315.
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