Presence of clinical guideline adoption-enabling elements in hospitals, organizational characteristics, and implementation of clinical guidelines
Abstract
The objectives of this study were to determine the presence in U.S. hospitals of clinical guideline adoption-enabling elements cited in the literature, assess associations between organizational characteristics including leader's openness to change, the institution's degree of centralization, formalization, complexity and size, and presence of guideline adoption-enabling elements in hospitals, and assess associations between presence of adoption-enabling elements and implementation of specific clinical guideline recommendations. A cross-sectional mail survey was conducted on a national random sample, stratified by state, of pharmacy directors in 236 general medical and surgical hospitals with more than 25 beds. Items were taken from pre-existing scales and revised for this study. Content validity of the survey scales was assessed based on expert panel ratings. Face-to-face and electronic-mail cognitive interviews were conducted with ten pharmacy directors to ensure that respondents were interpreting uniformly. The survey was pretested using 61 hospitals. Rasch analysis was used to identify and eliminate misfitting and redundant items and surveys. Multiple regression analysis was conducted to assess associations between organizational characteristics and presence of adoption-enabling elements, and associations between presence of adoption-enabling elements and guideline implementation. Pearson correlation was conducted for bivariate analysis of continuous variables and Spearman rank correlation was conducted for bivariate analysis of nonparametric variables. The survey response rate was 69.5 percent. On average, sample hospitals had implemented 66.9 percent of the adoption-enabling elements inquired about in the survey. Item reliability indices for scales evaluated in the study ranged from 0.86 to 0.99 and person reliability indices ranged from 0.41 to 0.91. Openness to change (p<0.0001), participation in decision-making (p<0.0001), and formalization (p<0.0001) were each significantly associated with presence of adoption-enabling elements. However, complexity (p = 0.1349) and size (p = 0.1949) were not associated with presence of adoption-enabling elements. Presence of adoption-enabling elements had a positive association with guideline implementation (p = 0.0447). Study findings indicate a modest presence of adoption-enabling elements in U.S. hospitals and significant influence of leaders' openness to change, centralization, and formalization on implementation of adoption-enabling elements in hospitals. The findings also indicate that the presence of adoption-enabling elements within a hospital is associated with higher levels of clinical guideline implementation.
Degree
Ph.D.
Advisors
Thomas, Purdue University.
Subject Area
Surgery|Pharmaceuticals|Health care
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