Table 2.

Effectiveness of Guideline Implementation Systems

Study	Methodology	Documentation	Adherence	Satisfaction	Outcomes
Bouhaddou et al.12	Time series without external control	Improved; indication of surgery	Improved; rate of request for surgery, mixed; increased preauthorization approval rate	Improved	Cost increased
Burack et al.13	RCT by patient	Nd	Increased use of mammography in health department setting, but not in HMO setting	Nd	Nd
Burack and Gimotty14
Day et al.15	Time series without external control	Improved after-care instructions	No effect	Nd	No effect on cost
Dexter et al.16	RCT by provider team	Nd	Increased discussion with intervention (24% vs. 4% without)	Nd	Improved rate of advance directive completion, 4% vs. 15%
Goethe et al.18	Time series without external control	Nd	Improved response to alerts	Nd	Nd
Litzelman et al.19	RCT by provider team	Nd	Improved mammography and fecal occult blood testing; no effect on Pap testing	Nd	Nd
Lobach and Hammond20	RCT by clinician	Nd	Two-fold increase in compliance with guidelines for 3 of 8 standards; failure for 5 of 8	Nd	Nd
Margolis et al.21	Time series without external control	Improved; 3 of 6 diseases	Improved for 2 of 6 diseases; decreased inappropriate use of antibiotics for 2 diseases	Too tedious, physicians refused to continue	Nd
Nilasena et al.22	RCT by physician	Nd	Improved average total compliance score for both control and intervention	70% found forms difficult to use and did not reduce time to provide care	Nd
Nilasena and Lincoln23
Ornstein et al.25	Time series without external control	Nd	Improved compliance with counseling, screening tests, breast exams, and thyroid function tests; no change for immunizations, fecal occult blood, Pap smear, mammography	No improvement in patient's perceived preventive services delivery	Nd
Overhage et al.26	RCT by provider team	Nd	No effect: control, 24% compliance rate; intervention, 23%	Nd	Nd
Robbins et al.27	Time series without external control	Nd	Nd	Nd	Cholesterol, LDL, and triglycerides levels decreased; HDL increased
Rossi and Every28	RCT by provider	Nd	Improved: 11.3% of patients changed to first line antihypertensive drugs	Nd	No significant change in BP
Safran et al.29	RCT by site	Nd	Improved: response time to alerts, 52 vs. 11 days	Nd	No change in admission rates, ER visits, survival or pneumocystis admissions
Schriger et al.30	Time series with switchback	Improved for 6 of 7 history items	Improved: 4 laboratory tests; 4 of 5 treatments	Nd	Cost: charges decreased for laboratory and prescriptions
Tape and Campbell31	Nonrandomized controlled trial by provider team	Nd	Improved sigmoidoscopy and immunization rates; no change in thyroxine, Pap, mammography, fecal occult blood screening	Nd	Nd
Turner et al.32	RCT by physician	Nd	Small improvement in health maintenance activities	Nd	Nd
Vincent et al.33	Time series without external control	Nd	Improved provider compliance; patient compliance improved for some	Nd	Nd
Willson et al.34	Time series without external control	Nd	Improved for both prevention and treatment protocols	Nd	Decrease in incidence of pressure ulcers
Zielstorff et al.36	Time series with control	Nd	No effect: clinical decision making	Positive for instructional adequacy and user satisfaction	Nd
Note: BP indicates blood pressure; Nd, not discussed; HDL, high-density lipoprotein; LDL, low-density lipoprotein; RCT, randomized controlled trial.