Question

Which implementation strategy generally displays the highest evidence of effectiveness in health care?

Answer 1

Most effective implementation strategies displays highest evidence of effectiveness in health care

Clinician/patient driven QIS were associated with stronger evidence of efficacy and larger effect sizes in health care. The most effective strategies included clinician-directed audit and feedback cycles, clinical decision support systems, specialty outreach programmes, chronic disease management programmes, continuing professional education based on interactive small-group case discussions, and patient-mediated clinician reminders.

Pay-for-performance schemes directed to clinician groups and organizational process redesign were modestly effective.

manager/policy-maker driven QIS including continuous quality improvement programmes, risk and safety management systems, public scorecards and performance reports, external accreditation, and clinical governance arrangements have not been adequately evaluated with regard to effectiveness.

Based on current best available evidence, clinician/patient driven QIS appear to be more effective than manager/policy-maker driven QIS although the latter have, in many instances, attracted insufficient robust evaluations to accurately determine their comparative effectiveness.