Chest
Volume 118, Issue 2, Supplement, August 2000, Pages 24S-32S
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Translating Guidelines Into Practice: Implementation and Physician Behavior Change
The Role of Clinical Opinion Leaders in Guideline Implementation and Quality Improvement

https://doi.org/10.1378/chest.118.2_suppl.24SGet rights and content

Background

The lag between the publication of clinical and health-services research and the application of this information is substantial and delays health-care improvement. A wide range of corrective strategies are being used to address this issue.

Objectives

Evolution in the use of significant opinion leaders is described. Hospital quality improvement projects, undertaken by the Healthcare Education and Research Foundation (HERF), are used to illustrate the roles assumed by clinical opinion leaders. Specific theoretical frameworks are reviewed that are fundamental to successful implementation of opinion leader strategies, as well as key research on the use of clinical opinion leaders.

Results

Over the past 12 years, HERF has identified the need to address not only the information needs of clinicians and organizations but also the social and organizational factors that interfere with the application of research and guidelines. The complexity of this task cannot be underestimated. However, armed with well-developed guidelines and the opportunity to work within structured guideline implementation programs with well-defined objectives and systematically applied methods, HERF's experience suggest local clinicians and communities can meet this challenge.

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

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