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Organizational interventions to encourage guideline implementation.

S J Curry1

  • 1Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA. curry.s@ghc.org

Chest
|August 12, 2000
PubMed
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Implementing evidence-based clinical practice guidelines requires strategic approaches. A "push-pull-capacity" model outlines methods for national, insurer, and purchaser organizations to enhance guideline adoption and improve healthcare delivery.

Area of Science:

  • Health Services Research
  • Medical Informatics
  • Healthcare Management

Background:

  • Evidence-based guidelines are crucial for improving healthcare.
  • Guideline availability alone does not ensure practice change.

Purpose of the Study:

  • To describe strategies for enhancing clinical practice guideline implementation.
  • To present a "push-pull-capacity" model for different healthcare organizations.

Main Methods:

  • The "push-pull-capacity" model categorizes implementation strategies.
  • Push strategies involve guideline development (rigorous review, expert teams).
  • Pull strategies create demand (endorsements, quality measures, incentives).
  • Capacity strategies build systems (reimbursement, IT infrastructure).

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Main Results:

  • Specific "push" strategies include meta-analysis and peer review.
  • Specific "pull" strategies involve professional endorsement and performance objectives.
  • Specific "capacity" strategies include reimbursement and clinical information systems.

Conclusions:

  • A multi-faceted "push-pull-capacity" approach is necessary for effective guideline implementation.
  • Tailored strategies are needed for national, insurer, and purchaser organizations.
  • Successful implementation can lead to improved healthcare delivery and outcomes.