La relación entre las características organizacionales y los efectos de las guías clínicas sobre el desempeño médico en los hospitales, un metanálisis

OBJECTIVE:

To measure the effectiveness of strategies to implement clinical guidelines and the influence of organisational characteristics on hospital care.

METHODS:

Systematic review and meta regression analysis including randomised controlled trials, controlled clinical trials and controlled before-and-after studies.

RESULTS:

53 studies were identified, including 81 comparisons. The total effect of all intervention strategies appeared to be Odds ratio 2.13 (SD 1.72-2.65). Intervention strategies (such as educational material, reminders, feedback) and other professional interventions that mostly comprised revisions of professional roles were found to be relatively strong components of multi faceted interventions. Outcomes of organisational effect modifiers were better in a learning environment in inpatient studies than in outpatient studies. Interventions developed outside hospitals yielded better outcomes; OR4.62 (SD 2.82-7.57) versus OR 1.78 (SD 1.36-2.23).

CONCLUSION:

Both single and multifaceted interventions seemed to be effective in hospital settings. Evidence for the effects of organisational determinants remained limited.