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Does Implementation of Evidence-based Guidelines Follow the Available Evidence? Implementation of Hypertension Guidelines at Veterans Affairs Medical Centers

Wyszewianski, Leon PhD; Kowalski, Christine MPH; Lowery, Julie PhD; Green, Lee A. MD, MPH

Quality Management in Healthcare: April-June 2007 - Volume 16 - Issue 2 - p 174–181
doi: 10.1097/01.QMH.0000267455.70747.92
Original Article

Background We sought to determine whether the proportion of strategies adopted in the implementation of evidence-based clinical guidelines by Department of Veterans Affairs medical centers (VAMCs) reflects an evidence-based assessment of the implementation strategies' relative effectiveness that was widely disseminated among VAMCs.

Methods We used data from a multisite observational study we conducted to test a model of changing clinical behaviors. For that study, we had compiled information from key informants at 43 VAMCs about strategies for implementing the VA's new hypertension management guidelines. We had subsequently classified the reported strategies into 41 categories. For this study, we matched these 41 categories to the 8 broad categories of implementation strategies in terms of which effectiveness of strategies had been reported to VAMCs. We compared the 8 categories' rank order on effectiveness with their ranking by number of VAMCs adopting the strategies.

Results The effectiveness-based rank ordering does not correspond with rank order based on percentage of VAMCs adopting (Spearman correlation coefficient = −0.4).

Discussion Results suggest that institutions, like practitioners, face barriers related to knowledge, attitudes, and behavior—including, in particular, insufficient resources—that impede their following the evidence when choosing guideline implementation strategies.

Department of Health Management and Policy, University of Michigan School of Public Health (Dr Wyszewianski); the Center for Practice Management & Outcomes Research, Ann Arbor VA Medical Center (Ms Kowalski and Dr Lowery); and the Department of Family Medicine, University of Michigan Medical School (Dr Green), Ann Arbor, Mich.

Corresponding author: Leon Wyszewianski, PhD, Department of Health Management and Policy, University of Michigan School of Public Health, 109 South Observatory, Ann Arbor, MI 48109 (e-mail:

Funded by a grant from the VA Health Services Research and Development Service in the Department of Veterans Affairs.

©2007Lippincott Williams & Wilkins, Inc.