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Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence—based implementation strategies.doc

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Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence—based implementation strategies

Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence—based implementation strategies ABSTRACT： To err is human. Clinical practice guidelines （CPGs） are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barriers and enablers. For the first time， a fishbone diagram is used to delineate the root-causes. And Haddon matrix is applied to help understand the complexity of evidence-based implementation （EBI） strategies. KEY WORDS： Clinical practice guideline；Implementation； Barriers； Enablers World J Emerg Med 2010；1（1）：6-11 DO WE FOLLOW CLINICAL PRACTICE GUIDELINES？ In health care， invention is hard， but dissemination is even harder. CPGs are systematically developed statements that assist practitioners to provide appropriate evidence-based care. CPG usage may differ at national level. Ian Graham et al[1] reported that more than 70 % of Canadian and UK emergency physicians applied Ottawa rules compared with less than one third of US， French， and Spanish physicians. Evidence-based management guidelines are prepared by authoritative parties and disseminated to members to minimize practice variation and maintain a standard quality of care. Problems arise during CPG dissemination， implementation and adherence. It is dangerous if members do not follow CPG. According to a newly published German study of 25 250 patients， only half of the patients were assigned appropriate LDL cholesterol targets.[2] If all doctors simply adhered to CPG， it could result in an estimated 50-80 fewer heart attacks， strokes and cardiovascular deaths per 1 000 patients over a 10 year period. In Israel， ACS patients with impaired physical and cognitive status had received less aspirin， clopidogrel， platelet glycoprotein IIb/IIIa receptor antagonists， statins， beta-blockers， and even less PCI. Subsequent mortality rate increas