ArticleHealth services research2007
Clinical practice guideline implementation strategy patterns in Veterans Affairs primary care clinics.
Article in Health services research, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 3 of them syntheses that pooled it.
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Who cites it
31 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies.BMJ quality & safety · 2019Pooled it
- What Defines a High-Performing Health Care Delivery System: A Systematic Review.Joint Commission journal on quality and patient safety · 2017Pooled it
- Pooled it
- Clinician-led improvement in cancer care (CLICC)--testing a multifaceted implementation strategy to increase evidence-based prostate cancer care: phased randomised controlled trial--study protocol.Implementation science : IS · 2014Trial
- A mixed methods multiple case study of implementation as usual in children's social service organizations: study protocol.Implementation science : IS · 2013Trial
- Study protocol: maintaining preventive care during public health emergencies through effective coordination.Implementation science communications · 2023Article
- How do healthcare providers use national audit data for improvement?BMC health services research · 2023Article
- Implementation-as-Usual in Community-Based Organizations Providing Specialized Services to Individuals with Autism Spectrum Disorder: A Mixed Methods Study.Administration and policy in mental health · 2021Article
- Getting a clinical innovation into practice: An introduction to implementation strategies.Psychiatry research · 2020Review
- Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention.Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing · 2020Article
- An observational study of a clinical guideline implementation project in primary care.Journal of clinical and translational science · 2019Article
- Nurses' Perceptions of a Care Plan Information Technology Solution With Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study.JMIR human factors · 2019Article
- Impact of a national QI programme on reducing electronic health record notifications to clinicians.BMJ quality & safety · 2019Article
- Clinical pathways for primary care: current use, interest and perceived usability.Journal of the American Medical Informatics Association : JAMIA · 2018Article
- Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs.Health services research · 2017Article
- Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy: study protocol for a cluster randomized trial.Addiction science & clinical practice · 2017Article
- User-centered design to improve clinical decision support in primary care.International journal of medical informatics · 2017Article
- Tracking implementation strategies: a description of a practical approach and early findings.Health research policy and systems · 2017Observational
- Barriers and Strategies in Guideline Implementation-A Scoping Review.Healthcare (Basel, Switzerland) · 2016Article
- A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project.Implementation science : IS · 2015Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success.
objectiveThis study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. RESEARCH
designDescriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. SUBJECTS: One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. MEASURES; Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews.
findingsHigh performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices.
conclusionA multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels.
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