Table 6 Overview of quantitative findings, narrative findings and certainty of evidence: implementation strategies compared with different or no active interventions for improving compliance with desired clinical practice and patient outcomesa,b,c
Types of interventions and comparisons | Impact | Outcomes and certainty of the evidence (GRADE) for meta-analytic results | ||||
|---|---|---|---|---|---|---|
Quantitative findings (meta-analyses) | Narrative findings | Continuous clinical practice outcomes | Dichotomous clinical practice outcomes | Continuous patient outcomes | Dichotomous patient outcomes | |
Any implementation strategy vs None | Implementation strategies as a whole, compared to no active intervention, probably improve compliance with desired clinical practice among nurses (moderate certainty of evidence). Implementation strategies may slightly improve patient outcomes (low certainty of evidence) | Among the 21 studies not included in the meta-analysis comparing any implementation strategy to no active intervention, 18 favored the experimental group for clinical practice outcomes | ⊕ ⊕ ⊕ ⊝ Moderate (26 CRTs, 23 RCTs, 21 NCRS) | ⊕ ⊕ ⊕ ⊝ Moderate (38 CRTs, 9 RCTs, 11 NCRS) | ⊕ ⊕ ⊝ ⊝ Low (6 CRTs, 2 RCTs, 2 NCRS) | ⊕ ⊕ ⊝ ⊝ Low (7 CRTs, 2 RCTs, 3 NCRS) |
Multifaceted strategies vs Single | Multifaceted implementation strategies, compared to single component strategies, may slightly improve compliance with desired clinical practice among nurses (low certainty of evidence) and patient outcomes (low to very low certainty of evidence) | Among the 4 studies not included in the meta-analysis comparing multifaceted implementation strategies to single strategies, all favored the experimental group for clinical practice outcomes | ⊕ ⊕ ⊝ ⊝ Low (3 CRTs, 6 RCTs, 3 NCRS) | ⊕ ⊕ ⊝ ⊝ Low (9 CRTs, 4 RCTs, 1 NCRS) | ⊕ ⊝ ⊝ ⊝ Very low (1 CRT, 1 RCT) | ⊕ ⊕ ⊝ ⊝ Low (3 CRTs) |
Group clinician education (GCE) vs No GCE | Implementation strategies including GCE, compared to strategies not including GCE or no active intervention, probably improve compliance with desired clinical practice among nurses (moderate certainty of evidence), and may slightly improve patient outcomes (moderate to low certainty of evidence) | Among the 18 studies not included in the meta-analysis comparing strategies with GCE to those without, 14 favored the experimental group for clinical practice outcomes | ⊕ ⊕ ⊕ ⊝ Moderate (25 CRTs, 24 RCTs, 19 NCRS) | ⊕ ⊕ ⊕ ⊝ Moderate (39 CRTs, 6 RCTs, 10 NCRS) | ⊕ ⊕ ⊕ ⊝ Moderate (6 CRTs, 2 RCTs) | ⊕ ⊕ ⊝ ⊝ Low (8 CRTs, 2 RCTs, 2 NRCS) |
Individual clinician education (ICE) vs No ICE | Implementation strategies including ICE, compared to strategies not including ICE or no active intervention, probably improve compliance with desired clinical practice in nurses (moderate to low certainty of evidence) and slightly improve patient outcomes (moderate certainty of evidence) | Among the 17 studies not included in the meta-analysis comparing strategies with ICE to those without, 15 favored the experimental group for clinical practice outcomes | ⊕ ⊕ ⊝ ⊝ Low (23 CRTs, 22 RCTs, 17 NCRS) | ⊕ ⊕ ⊕ ⊝ Moderate (34 CRTs, 7 RCTs, 12 NCRS) | ⊕ ⊕ ⊕ ⊝ Moderate (7 CRTs, 1 RCT, 2 NRCS) | ⊕ ⊕ ⊕ ⊝ Moderate (7 CRTs, 1 RCT, 3 NRCS) |
Reminders vs No Reminders | Implementation strategies including reminders, compared to no reminders or no active intervention, probably improve compliance with desired clinical practice in nurses (high to low certainty of evidence), but probably makes little to no difference in patient outcomes (moderate certainty of evidence) | Among the 4 studies not included in the meta-analysis comparing strategies with reminders to those without or no active intervention, 3 favored the experimental group for clinical practice outcomes | ⊕ ⊕ ⊝ ⊝ Low (4 CRTs, 2 RCTs, 5 NCRS) | ⊕ ⊕ ⊕ ⊕ High (16 CRTs, 5 RCTs, 2 NRCS) | ·· | ⊕ ⊕ ⊕ ⊝ Moderate (6 CRTs, 2 NRCS) |
Patient-mediated intervention (PMI) vs No PMI | Implementation strategies including a PMI, compared to no PMI or no active intervention, may improve compliance with desired clinical practice among nurses (low certainty of evidence), but we are uncertain about their effects on patient outcomes (low certainty of evidence) | ·· | ·· | ⊕ ⊕ ⊝ ⊝ Low (7 CRTs, 1 NRCS) | ·· | ⊕ ⊕ ⊝ ⊝ Low (2 CRTs) |
Audit and Feedback (A&F) vs No A&F | Implementation strategies including A&F, compared to no A&F or no active intervention, probably slightly improve compliance with desired clinical practice in nurses (moderate certainty of evidence), but may make little to no difference in patient outcomes (low to very low certainty of evidence) | Among the 14 studies not included in the meta-analysis comparing strategies with A&F to those without or no active intervention, 9 favored the experimental group for clinical practice outcomes, though 8 of these were multifaceted strategies | ⊕ ⊕ ⊕ ⊝ Moderate (5 CRTs, 2 NRCS) | ⊕ ⊕ ⊕ ⊝ Moderate (13 CRTs, 4 NRCS) | ⊕ ⊝ ⊝ ⊝ Very low (2 CRTs) | ⊕ ⊕ ⊝ ⊝ Low (6 CRTs, 2 NRCS) |
Tailored Intervention (TI) vs No TI | Tailored implementation strategies, compared to non-tailored strategies or no active intervention, improve compliance with desired clinical practice in nurses (high to moderate certainty of evidence) and probably improve slightly patient outcomes (moderate certainty of evidence) | Among the 5 studies not included in the meta-analysis comparing strategies with TI to those without or no active intervention, all favored the experimental group for clinical practice outcomes | ⊕ ⊕ ⊕ ⊝ Moderate (3 CRTs, 3 RCTs, 3 NRCS) | ⊕ ⊕ ⊕ ⊕ High (13 CRTs, 1 NRCS) | ⊕ ⊕ ⊕ ⊝ Moderate (2 CRTs, 1 RCT) | ⊕ ⊕ ⊕ ⊝ Moderate (5 CRTs, 1 NRCS) |
Opinion Leaders (OLs) vs No OLs | Implementation strategies including OLs, compared to no OLs or no active intervention, may improve compliance with desired clinical practice in nurses (low certainty of evidence), but probably make little to no difference in patient outcomes (moderate certainty of evidence) | Among the 5 studies not included in the meta-analysis comparing strategies with OLs to those without or no active intervention, 4 favored the experimental group for clinical practice outcomes | ⊕ ⊕ ⊝ ⊝ Low (1 CRT, 3 NRCS) | ⊕ ⊕ ⊝ ⊝ Low (12 CRTs, 1 NRCS) | ·· | ⊕ ⊕ ⊕ ⊝ Moderate (4 CRTs) |