Abstract
BackgroundGuideline implementation tools (GI tools) can improve clinician behavior and patient outcomes. Analyses of guidelines published before 2010 found that many did not offer GI tools. Since 2010 standards, frameworks and instructions for GI tools have emerged. This study analyzed the number and types of GI tools offered by guidelines published in 2010 or later.MethodsContent analysis and a published GI tool framework were used to categorize GI tools by condition, country, and type of organization. English-language guidelines on arthritis, asthma, colorectal cancer, depression, diabetes, heart failure, and stroke management were identified in the National Guideline Clearinghouse. Screening and data extraction were in triplicate. Findings were reported with summary statistics.ResultsEighty-five (67.5%) of 126 eligible guidelines published between 2010 and 2017 offered one or more of a total of 464 GI tools. The mean number of GI tools per guideline was 5.5 (median 4.0, range 1 to 28) and increased over time. The majority of GI tools were for clinicians (239, 51.5%), few were for patients (113, 24.4%), and fewer still were to support implementation (66, 14.3%) or evaluation (46, 9.9%). Most clinician GI tools were guideline summaries (116, 48.5%), and most patient GI tools were condition-specific information (92, 81.4%). Government agencies (patient 23.5%, clinician 28.9%, implementation 24.1%, evaluation 23.5%) and developers in the UK (patient 18.5%, clinician 25.2%, implementation 27.2%, evaluation 29.1%) were more likely to generate guidelines that offered all four types of GI tools. Professional societies were more likely to generate guidelines that included clinician GI tools.ConclusionsMany guidelines do not include any GI tools, or a variety of GI tools for different stakeholders that may be more likely to prompt guideline uptake (point-of-care forms or checklists for clinicians, decision-making or self-management tools for patients, implementation and evaluation tools for managers and policy-makers). While this may vary by country and type of organization, and suggests that developers could improve the range of GI tools they develop, further research is needed to identify determinants and potential solutions. Research is also needed to examine the cost-effectiveness of various types of GI tools so that developers know where to direct their efforts and scarce resources.
Highlights
Guideline implementation tools (GI tools) can improve clinician behavior and patient outcomes
Guidelines with GI tools Overall, 85 (67.5%) of the 126 guidelines were included or were accompanied by one or more GI tools (Table 3)
GI tools [18,19,20,21,22,23], and the existence of frameworks and instructions for developing GI tools [16, 25, 26], our study found that one third of guidelines examined did not offer any GI tools, the mean number of GI tools per guideline increased over time
Summary
Guideline implementation tools (GI tools) can improve clinician behavior and patient outcomes. Implementation research has largely focused on interventions targeting clinician determinants with limited and inconsistent impact on health care delivery or patient outcomes [9,10,11]. Far less research has focused on improving the content and format of guidelines to facilitate their adoption, a concept referred to as implementability [12]. Research shows that guidelines featuring implementation tools such as quick reference summaries for clinicians, educational material for patients, or indicators or benchmarks for performance measurement are used more often than guidelines lacking such content [16, 17]. The development and dissemination of guideline implementation tools (GI tools) represent an important way to improve the likelihood of guideline uptake
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