Author: Brian S McGowan, PhD

A b s t r a c t While evidence-based medicine has increasingly broad-based support in health care, it remains difficult to get physicians to actually practice it. Across most domains in medicine, practice has lagged behind knowledge by at least several years. The authors believe that the key tools for closing this gap will be information systems that provide decision support to users at the time they make decisions, which should result in improved quality of care. Furthermore, providers make many errors, and clinical decision support can be useful for finding and preventing such errors. Over the last eight years the authors have implemented and studied the impact of decision support across a broad array of domains and have found a number of common elements important to success. The goal of this report is to discuss these lessons learned in the interest of informing the efforts of others working to make the practice of evidence-based medicine a reality.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC264429/pdf/523.pdf

Background: Clinical practice guidelines are not uniformly successful in influencing clinicians’ behaviour toward best practices. Implementability refers to a set of characteristics that predict ease of (and obstacles to) guideline implementation. Our objective is to develop and validate a tool for appraisal of implementability of clinical guidelines.

http://www.biomedcentral.com/content/pdf/1472-6947-5-23.pdf

Context Despite wide promulgation, clinical practice guidelines have had limited effect on changing physician behavior. Little is known about the process and factors involved in changing physician practices in response to guidelines.
Objective To review barriers to physician adherence to clinical practice guidelines.

http://rds.epi-ucsf.org/ticr/syllabus/courses/66/2009/10/22/Lecture/readings/Cabana.JAMA.1999.pdf

This article reviews the history of guideline development and use, assesses the current state of implementation, identifies obstacles to adoption, and suggests strategies to overcome these obstacles. The major finding is that the current approach to development, dissemination, and encouraged use of guidelines is inconsistent with knowledge of psychology.

The major recommendations are that the approach to translation of evidence into practice be revised to address convenience; to respond to public and peer demand; to provide immediate feedback concerning performance; and to leverage existing incentives, transparencies, and accountabilities. Implementation of these recommendations is expected to augment safety and best practice in the health-care community.

http://www.jsmf.org/about/s/norms.pdf