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Using an interdisciplinary approach to identify factors that affect clinicians' compliance with evidence-based guidelines

Gurses, Ayse P. PhD; Marsteller, Jill A. PhD, MPP; Ozok, A. Ant PhD; Xiao, Yan PhD; Owens, Sharon PhD, CRNP; Pronovost, Peter J. MD, PhD

doi: 10.1097/CCM.0b013e3181e69e02
Psychology, Process Engineering, and Modification of Human Behaviors
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Objective: Our objective was to identify factors that affect clinicians' compliance with the evidence-based guidelines using an interdisciplinary approach and develop a conceptual framework that can provide a comprehensive and practical guide for designing effective interventions.

Design: A literature review and a brainstorming session with 11 researchers from a variety of scientific disciplines were used to identify theoretical and conceptual models describing clinicians' guideline compliance. MEDLINE, EMBASE, CINAHL, and the bibliographies of the papers identified were used as data sources for identifying the relevant theoretical and conceptual models.

Results: Thirteen different models that originated from various disciplines including medicine, rural sociology, psychology, human factors and systems engineering, organizational management, marketing, and health education were identified. Four main categories of factors that affect compliance emerged from our analysis: clinician characteristics, guideline characteristics, system characteristics, and implementation characteristics. Based on these findings, we developed an interdisciplinary conceptual framework that specifies the expected interrelationships among these four categories of factors and their impact on clinicians' compliance.

Conclusions: An interdisciplinary approach is needed to improve clinicians' compliance with evidence-based guidelines. The conceptual framework from this research can provide a comprehensive and systematic guide to identify barriers to guideline compliance and design effective interventions to improve patient safety.

From the Department of Anesthesiology and Critical Care Medicine (APG), The Johns Hopkins University School of Medicine and the Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore MD; Department of Health Policy and Management (JAM), The Johns Hopkins Bloomberg School of Public Health and Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Information Systems (AAO), UMBC, Baltimore, MD; Department of Patient Safety Research (YX), Baylor Health Care System, Dallas, TX; Cardiac Surgery (SO), Johns Hopkins Hospital, Baltimore, MD; Departments of Anesthesiology and Critical Care Medicine, and Surgery (APG, PJP), The Johns Hopkins University School of Medicine, School of Nursing, and Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

This work was supported by the James S. Todd Memorial Research Award from the National Patient Safety Foundation (Principal investigator Ayse P. Gurses, 2008–2009 Grant Cycle). Dr. Gurses reports receiving grant support from the Society of Cardiovascular Anesthesiologists. Dr. Xiao has received grant support from the National Science Foundation (Grant #: 0534646) and the Agency for Healthcare Research and Quality (R18 HS017908). Dr. Pronovost reports receiving honoraria from hospital associations and health systems to speak on quality and patient safety in addition to support from the Agency for Healthcare Research and Quality, Robert Wood Johnson Foundation, and other federal, non-federal, and not-for-profit organizations. The remaining authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: agurses1@jhmi.edu

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins