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Implementing guidelines in nursing homes: a systematic review

BACKGROUND: Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of i...

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Autores principales: Diehl, Heinz, Graverholt, Birgitte, Espehaug, Birgitte, Lund, Hans
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960750/
https://www.ncbi.nlm.nih.gov/pubmed/27456352
http://dx.doi.org/10.1186/s12913-016-1550-z
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author Diehl, Heinz
Graverholt, Birgitte
Espehaug, Birgitte
Lund, Hans
author_facet Diehl, Heinz
Graverholt, Birgitte
Espehaug, Birgitte
Lund, Hans
author_sort Diehl, Heinz
collection PubMed
description BACKGROUND: Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes. METHODS: A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE. RESULTS: Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE. CONCLUSIONS: Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes. PROTOCOL REGISTRATION: PROSPERO 2014:CRD42014007664 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-016-1550-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-49607502016-07-27 Implementing guidelines in nursing homes: a systematic review Diehl, Heinz Graverholt, Birgitte Espehaug, Birgitte Lund, Hans BMC Health Serv Res Research Article BACKGROUND: Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes. METHODS: A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE. RESULTS: Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE. CONCLUSIONS: Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes. PROTOCOL REGISTRATION: PROSPERO 2014:CRD42014007664 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-016-1550-z) contains supplementary material, which is available to authorized users. BioMed Central 2016-07-25 /pmc/articles/PMC4960750/ /pubmed/27456352 http://dx.doi.org/10.1186/s12913-016-1550-z Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Diehl, Heinz
Graverholt, Birgitte
Espehaug, Birgitte
Lund, Hans
Implementing guidelines in nursing homes: a systematic review
title Implementing guidelines in nursing homes: a systematic review
title_full Implementing guidelines in nursing homes: a systematic review
title_fullStr Implementing guidelines in nursing homes: a systematic review
title_full_unstemmed Implementing guidelines in nursing homes: a systematic review
title_short Implementing guidelines in nursing homes: a systematic review
title_sort implementing guidelines in nursing homes: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960750/
https://www.ncbi.nlm.nih.gov/pubmed/27456352
http://dx.doi.org/10.1186/s12913-016-1550-z
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