Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice

Medves, Jennifer; Godfrey, Christina; Turner, Carly; Paterson, Margo; Harrison, Margaret; MacKenzie, Lindsay; Durando, Paola

doi:10.1111/j.1744-1609.2010.00166.x

Cited by 80 publications

(76 citation statements)

References 99 publications

(137 reference statements)

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“…Speech pathologists indicated that educational meetings, educational resources, and support from colleagues were or would be the most useful strategy to assist with guideline implementation. This contrasts the extensive review on other health professionals where providing reminders was the most commonly reported effective strategy, followed by audit and feedback, opinion leaders, and educational outreach visits [18-20]. Speech pathologists in this study reported reminders to be the least effective strategy which was not expected.…”

Section: Discussioncontrasting

confidence: 89%

“…These facilitators were also reported by health professionals such as physicians, nurses, and occupational therapists previously [18-20,22,26,45]. Teamwork is a significant factor that influences the successfulness of stroke rehabilitation training programs and hence patient outcomes, such as functional gains [46] and length of hospital stay [47].…”

Section: Discussionmentioning

confidence: 85%

“…Although support from colleagues and educational meetings have been found to be effective in implementing guideline use [18,19], workplace policies have not been considered in previous studies [18-20]. Provision of a structural workplace policy or “rules” may be perceived as a guideline implementation strategy.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, some strategies that have promising evidence behind them were not provided to speech pathologists, whilst other strategies that were provided have questionable evidence. For example, despite the extensive literature that reports that external educational outreach visits were effective in implementing guidelines [18-20], only four speech pathologists were provided with this strategy. Whereas 15 participants were given financial incentives despite the inconclusive nature on the effectiveness of this strategy [19].…”

Section: Discussionmentioning

confidence: 99%

“…However another systematic review in 2008 [19], reported that multifaceted interventions, interactive education, and clinical reminder systems were effective. Finally, a systematic review by Medves and colleagues [20] on the strategies that enhance dissemination and implementation of clinical guidelines in healthcare teams, reported that the two most common strategies used to implement guidelines recommendations were educational materials and educational meetings; whilst the most effective strategies were reminders, audit and feedback, and opinion leaders. Although there is evidence on the variety of factors that influence guideline implementation by health professionals, the majority of these systematic reviews have focused on physicians, then nurses, with a small number of studies investigating other health professionals.…”

Section: Introductionmentioning

confidence: 99%

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Speech pathologists’ experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study

Hadely

Power

O’Halloran

2014

BMC Health Serv Res

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BackgroundCommunication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists’ implementation of stroke CPGs. This study aimed to describe speech pathologists’ experiences and current use of guidelines, and to identify what factors influence speech pathologists’ implementation of stroke CPGs.MethodsSpeech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data.Results320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline “somewhat useful” or “very useful”. Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided.ConclusionsThere are many different factors that can influence speech pathologists’ implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies.

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Speech pathologists’ experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study

Hadely

Power

O’Halloran

2014

BMC Health Serv Res

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Association of Team-Based Primary Care With Health Care Utilization and Costs Among Chronically Ill Patients

et al. 2019

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IMPORTANCE Empirical study findings to date are mixed on the association between team-based primary care initiatives and health care use and costs for Medicaid and commercially insured patients, especially those with multiple chronic conditions. OBJECTIVE To evaluate the association of establishing team-based primary care with patient health care use and costs. DESIGN, SETTING, AND PARTICIPANTS We used difference-indifferences to compare preutilization and postutilization rates between intervention and comparison practices with inverse probability weighting to balance observable differences. We fit a linear model using generalized estimating equations to adjust for clustering at 18 academically affiliated primary care practices in the Boston, Massachusetts, area between 2011 and 2015. The study included 83 953 patients accounting for 138 113 patient-years across 18 intervention practices and 238 455 patients accounting for 401 573 patient-years across 76 comparison practices. Data were analyzed between April and August 2018. EXPOSURES Practices participated in a 4-year learning collaborative that created and supported team-based primary care. MAIN OUTCOMES AND MEASURES Outpatient visits, hospitalizations, emergency department visits, ambulatory care-sensitive hospitalizations, ambulatory care-sensitive emergency department visits, and total costs of care. RESULTS Of 322 408 participants, 176 259 (54.7%) were female; 64 030 (19.9%) were younger than 18 years and 258 378 (80.1%) were age 19 to 64 years. Intervention practices had fewer participants, with 2 or more chronic conditions (n = 51 155 [37.0%] vs n = 186 954 [46.6%]), more participants younger than 18 years (n = 337 931 [27.5%] vs n = 74 691 [18.6%]), higher Medicaid enrollment (n = 39 541 [28.6%] vs n = 81 417 [20.3%]), and similar sex distributions (75 023 women [54.4%] vs 220 097 women [54.8%]); however, after inverse probability weighting, observable patient characteristics were well balanced. Intervention practices had higher utilization in the preperiod. Patients in intervention practices experienced a 7.4% increase in annual outpatient visits relative to baseline (95% CI, 3.5%-11.3%; P < .001) after adjusting for patient age, sex, comorbidity, zip code level sociodemographic characteristics, clinician characteristics, and plan fixed effects. In a subsample of patients with 2 or more chronic conditions, there was a statistically significant 18.6% reduction in hospitalizations (95% CI, 1.5%-33.0%; P = .03), 25.2% reduction in emergency department visits (95% CI, 6.6%-44.0%; P = .007), and a 36.7% reduction in ambulatory care-sensitive emergency department visits (95% CI, 9.2%-64.0%; P = .009). Among patients with less than 2 comorbidities, there was an increase in outpatient visits (9.

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The role of dissemination and implementation science in global breast cancer control programs: Frameworks, methods, and examples

Rositch

Unger‐Saldaña

DeBoer

et al. 2020

Cancer

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Global disparities in breast cancer outcomes are attributable to a sizable gap between evidence and practice in breast cancer control and management. Dissemination and implementation science (D&IS) seeks to understand how to promote the systematic uptake of evidence-based interventions and/or practices into real-world contexts. D&IS methods are useful for selecting strategies to implement evidence-based interventions, adapting their implementation to new settings, and evaluating the implementation process as well as its outcomes to determine success and failure, and adjust accordingly. Process models, explanatory theories, and evaluation frameworks are used in D&IS to develop implementation strategies, identify implementation outcomes, and design studies to evaluate these outcomes. In breast cancer control and management, research has been translated into evidence-based, resource-stratified guidelines by the Breast Health Global Initiative and others. D&IS should be leveraged to optimize the implementation of these guidelines, and other evidencebased interventions, into practice across the breast cancer care continuum, from optimizing public education to promoting early detection, increasing guideline-concordant clinical practice among providers, and analyzing and addressing barriers and facilitators in health care systems. Stakeholder engagement through processes such as co-creation is critical. In this article, the authors have provided a primer on the contribution of D&IS to phased implementation of global breast cancer control programs, provided 2 case examples of ongoing D&IS research projects in Tanzania, and concluded with recommendations for best practices for researchers undertaking this work. Cancer 2020;126:2394-2404.

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Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice

Abstract: Team-based care using practice guidelines locally adapted can affect positively patient and provider outcomes.

Cited by 80 publications

References 99 publications

Speech pathologists’ experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study

Speech pathologists’ experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study

Association of Team-Based Primary Care With Health Care Utilization and Costs Among Chronically Ill Patients

The role of dissemination and implementation science in global breast cancer control programs: Frameworks, methods, and examples

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