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Attributes of clinical recommendations that influence change in practice following audit and feedback

Lookup NU author(s): Dr Robbie Foy, Professor Jeremy Grimshaw


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Publication metadata

Author(s): Foy R; Grimshaw J; MacLennan G; Penney G; Campbell M; Grol R

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Epidemiology

Year: 2002

Volume: 55

Issue: 7

Pages: 717-722

ISSN (print): 0895-4356

ISSN (electronic): 1878-5921

Publisher: Elsevier Inc.


DOI: 10.1016/S0895-4356(02)00403-1

Notes: The implementation of clinical guidelines represents a considerable challenge to guideline developers, quality improvement leads and clinicians. Various factors can influence the effectiveness of interventions to promote guideline implementation. Whilst much work has focused on characteristics of clinicians or healthcare organisations, little work has addressed the nature of guideline recommendations themselves. This study determined which attributes of clinical practice recommendations influenced changes in practice following audit and feedback. Within an observational study design, multilevel modelling was used to examine the relationship between various attributes of recommendations and compliance with the recommendations before and after audit and feedback. Similar work in this area has only looked at compliance with recommendations (i.e. a one-off measure of performance). However, clinical guidelines are produced to promote change in behaviour (i.e. an increase in compliance), which this investigation found were different from those associated with compliance. This study found that recommendations incompatible with clinician values were independently associated with greater change in practice following audit and feedback following audit and feedback – even after accounting for lower baseline (pre-feedback) compliance. Those responsible for quality improvement may feel deterred from pushing recommendations perceived to be unacceptable to clinicians. However, this study suggests that greater quality gains are possible when these are targeted using audit and feedback.


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