Research indicates that clinical guidelines are often not applied. The success of their implementation depends on the consideration of a variety of barriers and the use of adequate strategies to overcome them. Therefore, this scoping review aims to describe and categorize the most important barriers to guideline implementation. Furthermore, it provides an overview of different kinds of suitable strategies that are tailored to overcome these barriers. The search algorithm led to the identification of 1659 articles in PubMed. Overall, 69 articles were included in the data synthesis. The content of these articles was analysed by using a qualitative synthesis approach, to extract the most important information on barriers and strategies. The barriers to guideline implementation can be differentiated into personal factors, guideline-related factors, and external factors. The scoping review revealed the following aspects as central elements of successful strategies for guideline implementation: dissemination, education and training, social interaction, decision support systems and standing orders. Available evidence indicates that a structured implementation can improve adherence to guidelines. Therefore, the barriers to guideline implementation and adherence need to be analysed in advance so that strategies that are tailored to the specific setting and target groups can be developed.

PurposeTo test whether or not adults assign the same values to hypothetical health states that describe health in adults as when those same descriptions refer to the health of a child.MethodsA two-part self-completion questionnaire was designed in which respondents were asked firstly to rate a fixed set of EQ-5D-Y health states on a 0–100 visual analogue scale as if they themselves were in these states. Two versions of the questionnaire were produced each with a different second part. One version instructed respondents to value the same states but to imagine them describing another adult. The second version required respondents to value these states as if they applied to a 10-year-old child. Questionnaires were distributed to adults recruited in three countries (Germany, Spain and England) using convenience sampling methods.ResultsA total of 1085 questionnaires were completed. Despite some significant differences in the characteristics of the achieved samples in the three countries involved, the rank order of health states was largely consistent across each adult/child reference perspective. In all countries, the mean values were lower when health states described children rather than adults. Significant differences were found for 16/24 states when values for those states applied to adult respondent themselves were compared with the values for those states applied to a 10-year-old child. A near-uniform pattern was found across all three countries in which health state values for children were found to be lower than for adults.ConclusionsValues for health states when ascribed to adults are higher than when those same states are associated with children. Were EQ-5D-3L values for adults applied to EQ-5D-Y health states, then this would effectively lead to an misrepresentation of the value assigned to a health status in children.

With the shift towards patient-centered healthcare, patient- and person-reports of health-related factors, including outcomes, are seen as important determinants for evaluating and improving healthcare. However, a comprehensive, systematic categorization of patient- and person-reports is currently lacking in the literature. This study aims at developing a new classification system with well-defined constructs for patients’ and persons’ self-reports on health and healthcare. A literature research and evaluation by the Reported Health Outcomes (RHO) Group were used to develop this classification system. The new classification system includes patient- and person-reported preferences, outcomes, experiences, and satisfaction related to healthcare and health outcomes. Moreover, the most constitutive methods to measure these four categories – preferences, outcomes, experiences, and satisfaction – have been described in this article. Even though the value of patients’ and persons’ perspectives on healthcare is increasingly being recognized, its measurement and implementation presents a lasting challenge to researchers, clinicians, patients, and the general population.

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Zusammenfassung Die neurologische Fr?hrehabilitation nach Schlaganfall ist ein wesentlicher Faktor, um den Behinderungsgrad langfristig zu senken. Je fr?her die rehabilitative Behandlung von Schlaganfallpatienten einsetzt, desto besser ist das funktionelle Outcome. Mit einem eigens entwickelten Erhebungsinstrument wurden Daten von 333 Schlaganfallpatienten in 3 Hamburger Fr?hrehabilitationseinrichtungen ?ber 20 Monate gesammelt und deskriptiv analysiert. Es ergaben sich unterschiedliche R?ckbildungstendenzen der verschiedenen Symptome, einen nicht unerheblichen Anteil an Komplikationen und eine relativ hohe Rate an weiterf?hrenden station?ren rehabilitativen Ma?nahmen. Die entwickelten Qualit?tsindikatoren decken die relevanten Aspekte der Rehabilitation mit wenigen Kennzahlen ab. Aus den erhobenen Daten l?sst sich ein Qualit?tsmanagement-System entwickeln, um die Behandlungsqualit?t weiter zu verbessern.