gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Does using a sustainability model for guideline implementation on multiple topics in multiple sites make a difference?

Meeting Abstract

  • B. Davies - University of Ottawa, Ottawa, Canada
  • K. Higuchi - University of Ottawa, Ottawa, Canada
  • J. Ellis - University of Ottawa, Ottawa, Canada
  • S. Ireland - McMasterUniversity, Hamilton, ON, Canada
  • J. Ploeg - McMasterUniversity, Hamilton, ON, Canada
  • M.A. Murray - University of Ottawa, Ottawa, Canada
  • M. Taljaard - Ottawa Hospital Research Institute, Ottawa, Canada
  • E. Soto - University of Ottawa, Ottawa, Canada

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocO26

DOI: 10.3205/12gin058, URN: urn:nbn:de:0183-12gin0587

Veröffentlicht: 10. Juli 2012

© 2012 Davies et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: Failure to sustain guideline-based organizational change at two-years is 41-70% with limited evaluation of prospective theory-based sustainability-oriented guideline implementation. The NHS sustainability model was developed by 250 experts in the UK with 10 factors clustered about process, staff and organizational determinants.

Objectives: To measure the impact of sustainability-oriented guideline implementation on patient care in hospitals, primary care and home care services annually for three years.

Methods: A longitudinal pre-post mixed methods design with nine health care organizations implementing guidelines (breastfeeding, delirium-dementia-depression, fall prevention, pain management, smoking cessation, wound care). Intervention included interviews (leaders, care providers n=90), focus groups (inter-professional steering committee n=83), sustainability action planning at monthly mentoring teleconferences, and provision of annual site-specific sustainability scores and patient outcomes.

Results: Baseline sustainability scores ranged from 35.4-77.3% (mean 66.4%). Infrastructure for sustainability was low at 56.8%. Participants reported that site-specific scores with illustrative quotes identified perceived barriers of providers, teams and organizational systems. Selected priority process and patient outcomes improved at 7 of 9 sites (p≤.05, and/or clinically relevant change of ≥15%) from baseline.

Discussion: The mean NHS model sustainability score (66.4%) is higher than the recommended 55% for launching implementation initiatives. Low scores were useful to identify factors that needed further attention. Improvements in priority patient outcomes were promising.

Implications: Guideline users need to think beyond 1 year pilot implementations with inter-professional perspectives to maximize adaptability to the context and minimize implementation erosion over time.