The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis
| Autor: | Michel Wensing, Ruth Thomas, Reinier Akkermans, Richard Grol, R.F. Dijkstra, Jozé Braspenning, Jeremy M. Grimshaw |
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| Rok vydání: | 2006 |
| Předmět: |
medicine.medical_specialty
Quality Assurance Health Care Psychological intervention Health administration Hospital Administration medicine Humans Organizational Objectives Meta-regression Evidence-Based Medicine business.industry lcsh:Public aspects of medicine Health Policy Nursing research Health services research lcsh:RA1-1270 Evidence-based medicine Organizational Culture Clinical trial Leadership Research Design Meta-analysis Family medicine Health Facility Environment Practice Guidelines as Topic Guideline Adherence Health Services Research business Research Article |
| Zdroj: | BMC Health Services Research BMC Health Services Research, Vol 6, Iss 1, p 53 (2006) |
| ISSN: | 1472-6963 |
| DOI: | 10.1186/1472-6963-6-53 |
| Popis: | ObjectiveTo measure the effectiveness of strategies to implement clinical guidelines andthe influence of organisational characteristics on hospital care.MethodsSystematic review and meta regression analysis including randomisedcontrolled trials, controlled clinical trials and controlled before-and-after studies.Results53 studies were identified, including 81 comparisons. The total effect of allintervention strategies appeared to be Odds ratio 2.13 (SD 1.72-2.65). Interventionstrategies (such as educational material, reminders, feedback) and other professionalinterventions that mostly comprised revisions of professional roles were found to berelatively strong components of multi faceted interventions. Outcomes of organisationaleffect modifiers were better in a learning environment in inpatient studies than inoutpatient studies. Interventions developed outside hospitals yielded better outcomes; OR4.62 (SD 2.82-7.57) versus OR 1.78 (SD 1.36-2.23).ConclusionBoth single and multifaceted interventions seemed to be effective in hospitalsettings. Evidence for the effects of organisational determinants remained limited. |
| Databáze: | OpenAIRE |
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