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Translating Guidelines Into Practice: Implementation and Physician Behavior ChangeThe Role of Clinical Opinion Leaders in Guideline Implementation and Quality Improvement
Section snippets
Diffusion Innovation Research
For the past 50 years, research has been undertaken to understand how and why certain types of innovations and changes are accepted or rejected. Innovation diffusion research isolates important characteristics of the innovation that influence individuals to change their behavior. Everett Rogers910 defines diffusion as the process by which (1) an innovation that is perceived as new by an individual or a group (2) is communicated through certain channels (3) over time (4) among the members of a
Materials and Methods
The design of this study was a randomized controlled trial involving 37 hospitals throughout Minnesota. The specific quality of care measures being evaluated were the use of several highly effective drugs for eligible patients (ie, thrombolytics, aspirin, β-blockers) and the avoidance of prophylactic lidocaine.
The HERF staff (ie, specially trained coronary care unit, ICU, and emergency department nurses) collected very detailed information from patient records. Patient eligibility for the four
Results
The effectiveness of this intervention was determined by analysis of preintervention vs postintervention changes in (1) the proportion of eligible patients receiving each of the effective drug categories, and (2) the proportion of patients without indication who received lidocaine.
Overall, the intervention resulted in a significant increase in aspirin and β-blocker use. Among experimental hospitals, the median change in the proportion of eligible elderly receiving aspirin was + 0.13 (17%
Conclusion
Great progress has been made in developing clinical guidelines due to the efforts of the Agency for Health Care Policy Research and national medical-specialty societies. Research has shown the effectiveness of structured implementation strategies and the value of clinical opinion leader involvement in these efforts.
Projects undertaken by HERF have consistently relied on local clinical opinion leaders to not only endorse but also to lend their expertise to implementing guideline and quality
References (33)
Lessons for guidelines from the diffusion of innovations Joint Commission
J Qual Improvement
(1995)- et al.
A critical review of interventions to improve compliance with prescribed medications
Patient Educ Counseling
(1987) - et al.
Implementing clinical practice guidelines: social influence strategies and practitioner behavior change
Qual Rev Bull
(1992) Gray zones of clinical practice: some limits to evidence-based medicine
Lancet
(1995)The shape of resistance… the shapers of change
J Qual Improvement
(1995)The state of the art versus the state of the science
Int J Technol Assess Health Care
(1988)- et al.
No magic bullets: a systematic review of 102 trials of interventions to improve professional practice
Can Med Assoc J
(1995) - et al.
Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings
BMJ
(1998) - et al.
Opinion leaders vs audit and feedback to implement practice guidelines: delivery after previous cesarean section
JAMA
(1991) - et al.
Local opinion leaders to improve health professional practice and health care outcomes
The Minnesota clinical comparison and assessment program: bridging the gap between clinical practice guidelines and patient care
The Minnesota clinical comparison and assessment program: bridging the gap between clinical practice guidelines and patient care
Joint Commission J Qual Improvement
Effect of local medical opinion leaders on quality of care for acute myocardial infarction
JAMA
Changing physicians' practices
N Engl J Med
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