Evaluating a Multi-Hospital Quality Improvement Strategy to Implement Clinical Guidelines for Radiographic Contrast Agents

Considerable resources are being devoted to development of evidence-based clinical practice guidelines that are designed to improve the quality and value of medical care and to promote the responsible proliferation of new medical technologies. Unfortunately, the development and dissemination of guidelines typically is insufficient to influence practice behavior. Until successful implementation strategies can be developed that take into account the organizational context of medical practice, the goals underlying development of scientifically valid guidelines will not be achieved. This report provides results from a randomized, controlled trial and qualitative evaluation of a quality improvement strategy to implement clinical guidelines for radiographic contrast agents. The strategy involved training hospital representatives in quality improvement methods to implement the guidelines in their own hospitals, using a step-by-step guideline implementation protocol and other tailored resources. Overall, the strategy was unsuccessful in improving adherence to the guidelines in the intervention group. A comparative case study was conducted to examine the impact of key organizational factors on adherence and to identify successful strategies for overcoming barriers to adherence. Intra-organizational financial incentives were found to be particularly important in predicting the extent of guideline adherence. Specific recommendations for managers, policymakers, and researchers are presented.