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

Abstract

Abstract Objective To measure the effectiveness of strategies to implement clinical guidelines andthe influence of organisational characteristics on hospital care. Methods Systematic review and meta regression analysis including randomisedcontrolled trials, controlled clinical trials and controlled before-and-after studies. Results 53 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). Conclusion Both single and multifaceted interventions seemed to be effective in hospitalsettings. Evidence for the effects of organisational determinants remained limited.