Objectives: A systematic review of the effectiveness and costs of different guideline development, dissemination, and implementation strategies wasundertaken. The resource implications of these strategies was estimated, and a framework for deciding when it is efficient to develop and introduce clinical guidelines was developed.

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Objective: To measure the effectiveness of strategies to implement clinical guidelines and the influence of organisational characteristics on hospital care.Methods: Systematic review and meta regression analysis including randomised controlled trials, controlled clinical trials and controlled before-and-after studies.Results: 53 studies were identified, including 81 comparisons. The total effect of all intervention strategies appeared to be Odds ratio 2.13 (SD 1.72-2.65). Intervention strategies (such as educational material, reminders, feedback) and other professional interventions that mostly comprised revisions of professional roles were found to be relatively strong components of multi faceted interventions. Outcomes of organisational effect modifiers were better in a learning environment in inpatient studies than in outpatient studies. Interventions developed outside hospitals yielded better outcomes; OR 4.62 (SD 2.82-7.57) versus OR 1.78 (SD 1.36-2.23). Conclusion:Both single and multifaceted interventions seemed to be effective in hospital settings. Evidence for the effects of organisational determinants remained limited.

Background: Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices.

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