Predictors of the Growing Influence of Clinical Practice Guidelines

Abstract

Despite the proliferation of clinical practice guidelines (CPGs), physicians have been slow to adopt them. Describe changes in the reported effect of CPGs on physicians' clinical practice over the past decade, and identify the practice characteristics associated with those changes. Longitudinal and cross-sectional analyses of rounds 1-4 of the Community Tracking Study Physician Survey, a nationally representative survey, conducted periodically between 1996 and 2005. The cross-sectional outcome was the reported effect of CPGs on the physician's practice (very large, large, moderate, small, very small, and no effect). The longitudinal outcome was the change in reported effect of CPGs between two consecutive rounds for panel respondents. Independent variables included changes in physicians' practice characteristics (size, ownership, capitation, availability of information technology (IT) to access guidelines, whether quality measures and profiling affect compensation, and revenue sources). The proportion of primary care physicians reporting that CPGs had a very large or large effect on their practice increased significantly from 1997 to 2005, from 16.4% to 38.7% (P < .0001). The corresponding change for specialists was 18.9% to 28.2% (P < .0001). In longitudinal multivariate analyses, practice characteristics associated with an increase in effect of CPGs included acquiring IT to access guidelines, an increase in the impact that quality measures and profiling have on compensation, and an increase in the proportion of practice revenue under capitation or derived from Medicaid. Promotion of wider adoption of health IT, and financial incentives linked to validated quality measures, may facilitate further growth in the impact of CPGs.