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Published on: February 19, 2021
Strategies for dissemination and implementation of guidelines
1Unit of Clinical Epidemiology, IRCCS Policlinico S. Matteo, Pavia, Italy. barosig@smatteo.pv.it
Summary
Implementing clinical practice guidelines (CPG) and integrated clinical pathways (ICP) for stroke care shows varied effectiveness. While adherence to CPG predicts better outcomes, ICPs offer specific benefits like reduced infections and readmissions, though not impacting mortality.
Area of Science:
- Health Services Research
- Clinical Effectiveness
- Evidence-Based Medicine
Background:
- Clinical practice guidelines (CPG) and integrated clinical pathways (ICP) are crucial for standardizing stroke care.
- Systematic reviews have assessed the effectiveness and costs of various guideline dissemination and implementation strategies.
- Physician adherence to CPG is a significant factor influencing stroke patient outcomes.
Purpose of the Study:
- To systematically review the effectiveness and costs of different strategies for developing, disseminating, and implementing clinical practice guidelines.
- To evaluate the impact of integrated clinical pathways (ICP) for stroke care compared to standard medical care.
- To assess the evidence for multifaceted strategies in implementing stroke care ICPs.
Main Methods:
- Systematic review of guideline development, dissemination, and implementation strategies.
- Cochrane Collaboration systematic review comparing ICP for stroke care with standard medical care (studies up to 2004).
- Analysis of dichotomous process data and evaluation studies on adherence and outcomes.
Main Results:
- Most comparisons showed improvements in care, but with considerable variation in intervention effects.
- No significant difference in death or discharge destination between ICP and standard care for stroke.
- Patients on ICP pathways experienced fewer urinary tract infections, less readmission, more neuroimaging, but were more dependent at discharge.
- A validation study reported positive effects of a multifaceted strategy for ICP implementation in Italy.
Conclusions:
- Adherence to CPG is a strong predictor of stroke outcomes.
- Integrated clinical pathways (ICP) for stroke care demonstrate specific benefits, including reduced infections and readmissions, despite not altering mortality or discharge destination significantly.
- Multifaceted implementation strategies show promise for improving stroke care pathway adoption.
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