Table 5

CQ 4: Contextual Factors That Appear to Facilitate the Success of the Intervention Strategies

ContextKey Facilitators
Characteristics of GuidelinesShort and simple format (47)
Provide patient pamphlets (47)
Easy to understand and use (48)
Minimal resources needed to implement (48)
Involving end-users in guidelines development, implementation, and testing (15,48,50,52)
Use of computerized guidelines in practice settings (15,16)
Involving StakeholdersInvolvement in planning, developing, or leading interventions designed to influence practice patterns and clinical outcomes (19,30,34,40,56)
LeadershipLeader’s social influence is recognized (30)
Formal leadership (40)
Local management support and enthusiasm (24,51)
Adequate time to promote new practice (24)
Scope of ImplementationProvider incentives—more broadly implemented in the United Kingdom with more consistent results than in the United States (19)
Multifaceted interventions are more likely to be effective than single interventions (24,26,53,54)
Organizational CultureMultidisciplinary teams, coordination of care, pace of change, a blame-free culture, and a history of quality improvement (9,19,28,38)
Low-baseline adherence (19,29,34,38,40,46,55)
Workflow and TimingElectronic guidelines systems
  • Integration with computers used in practice (16,17)

  • Reminders automatic—clinicians not required to seek information (42)

CQ indicates clinical question.