The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis

O bjective: To measure the effectiveness o f strategies to implement clinical guidelines and the influence o f 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 8 l comparisons. The total effect o f all intervention strategies appeared to be Odds ratio 2 .13 (SD l .72-2.65). Intervention strategies (such as educational material, reminders, feedback) and o ther professional interventions that mostly comprised revisions o f professional roles were found to be relatively strong components o f multi faceted interventions. Outcomes o f 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 l.78 (SD l .36-2.23). Conclusion: Both single and multifaceted interventions seemed to be effective in hospital settings. Evidence fo r the effects o f organisational determinants remained limited. Background Systematic reviews in various health care settings have demonstrated that different implementation interven­ tions have varying effects. [1,2]. Most interventions to im plement clinical guidelines focused on changing pro­ fessional behaviour, bu t there is increasing awareness that factors related to the social, organisational and economi­ cal context can also be important determinants of guide­ line implementation[3]. For instance, a recent study on the implementation of screening guidelines in ambula­ tory settings has confirmed the influence of a num ber of organisational factors, such as mission, capacity and professionalism[4]. Despite increasing attention to organisa­ tional determinants of guideline implementation, research evidence on the relevance of specific factors is still limited. Insight into these factors is im portant as it