TY - JOUR
T1 - The effect of provider-and workflow-focused strategies for guideline implementation on provider acceptance
AU - Flanagan, Mindy E.
AU - Ramanujam, Rangaraj
AU - Doebbeling, Bradley N.
N1 - Funding Information:
This study was funded through the Department of Veterans Affairs, the Veterans Health Administration, Health Services Research and Development Service, Investigator Initiated Research Grants, #CPI99-126 and CPI -01-141. MEF was a VA postdoctoral fellow in medical informatics. This research was partially supported by VA HSRD Center grant #HFP 04-148. We appreciate the contributions of the multiple investigators in our study group at Iowa City (Thomas Vaughn, Marcia Ward, Robert Woolson, Steve Flach, Toni Tripp-Reimer, Bernard Sorofman, Jane DeWitt) and Indianapolis (Anne Chou, Jason Sutherland) who contributed to the design and conduct of the study. We also greatly appreciate the time and effort of providers and managers who participated in the study. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
PY - 2009
Y1 - 2009
N2 - Background. The effective implementation of clinical practice guidelines (CPGs) depends critically on the extent to which the strategies that are deployed for implementing the guidelines promote provider acceptance of CPGs. Such implementation strategies can be classified into two types based on whether they primarily target providers (e.g., academic detailing, grand rounds presentations) or the work context (e.g., computer reminders, modifications to forms). This study investigated the independent and joint effects of these two types of implementation strategies on provider acceptance of CPGs. Methods. Surveys were mailed to a national sample of providers (primary care physicians, physician assistants, nurses, and nurse practitioners) and quality managers selected from Veterans Affairs Medical Centers (VAMCs). A total of 2,438 providers and 242 quality managers from 123 VAMCs participated. Survey items measured implementation strategies and provider acceptance (e.g., guideline-related knowledge, attitudes, and adherence) for three sets of CPGs-chronic obstructive pulmonary disease, chronic heart failure, and major depressive disorder. The relationships between implementation strategy types and provider acceptance were tested using multi-level analytic models. Results. For all three CPGs, provider acceptance increased with the number of implementation strategies of either type. Moreover, the number of workflow-focused strategies compensated (contributing more strongly to provider acceptance) when few provider-focused strategies were used. Conclusion. Provider acceptance of CPGs depends on the type of implementation strategies used. Implementation effectiveness can be improved by using both workflow-focused as well as provider-focused strategies.
AB - Background. The effective implementation of clinical practice guidelines (CPGs) depends critically on the extent to which the strategies that are deployed for implementing the guidelines promote provider acceptance of CPGs. Such implementation strategies can be classified into two types based on whether they primarily target providers (e.g., academic detailing, grand rounds presentations) or the work context (e.g., computer reminders, modifications to forms). This study investigated the independent and joint effects of these two types of implementation strategies on provider acceptance of CPGs. Methods. Surveys were mailed to a national sample of providers (primary care physicians, physician assistants, nurses, and nurse practitioners) and quality managers selected from Veterans Affairs Medical Centers (VAMCs). A total of 2,438 providers and 242 quality managers from 123 VAMCs participated. Survey items measured implementation strategies and provider acceptance (e.g., guideline-related knowledge, attitudes, and adherence) for three sets of CPGs-chronic obstructive pulmonary disease, chronic heart failure, and major depressive disorder. The relationships between implementation strategy types and provider acceptance were tested using multi-level analytic models. Results. For all three CPGs, provider acceptance increased with the number of implementation strategies of either type. Moreover, the number of workflow-focused strategies compensated (contributing more strongly to provider acceptance) when few provider-focused strategies were used. Conclusion. Provider acceptance of CPGs depends on the type of implementation strategies used. Implementation effectiveness can be improved by using both workflow-focused as well as provider-focused strategies.
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U2 - 10.1186/1748-5908-4-71
DO - 10.1186/1748-5908-4-71
M3 - Article
C2 - 19874607
AN - SCOPUS:73249134551
SN - 1748-5908
VL - 4
JO - Implementation Science
JF - Implementation Science
IS - 1
M1 - 71
ER -