Evaluation of the Use of Guidelines

About the research guide

Authors: Melissa Jennings and Goldie MacDonald.

This Research Guide includes open access examples of different ways to evaluate the use of guidelines from a variety of authors in clinical, public health, and laboratory settings. The World Health Organization defines guidelines as documents that contain recommendations about interventions used in clinical and public health policy or practice.12

The materials are organized according to the focus of the evaluation: attitudes or knowledge related to adherence to guidelines; factors that facilitate or hinder the implementation of guidelines; differences in how health care providers use guidelines; clinician adherence to guidelines; adherence to laboratory and clinical guidelines; and adherence to guidelines among specific populations. The last section includes approaches, methods, or tools that can be applied to evaluate guidelines use. The authors completed a detailed literature search and reviewed candidate items according to predetermined criteria.

Examine attitudes or knowledge related to adherence to guidelines

• Women's responses to changes in U.S. preventive task force's mammography screening guidelines: results of focus groups with ethnically diverse women Allen, Jennifer, D., Bluethmann, S. M., Sheets, M., Opdyke, K. M., Gates-Ferris, K., Hurlbert, M., Harden, E. (2013). BMC Public Health. 13(1), 1169. doi:10.1186/1471-2458-13-1169
• Effectiveness of multifaceted and tailored strategies to implement a fall-prevention guideline into acute care nursing practice: a before-and-after, mixed-method study using a participatory action research approach Breimaier, Helga E., Halfens, R. J., Lohrmann, C. J. BMC Nursing. (2015). 14(1), 18. doi:10.1186/s12912-015-0064-z
• Factors associated with primary care physician knowledge of the recommended regimen for treating gonorrhea Bornstein, Marta., Ahmed, F., Barrow, R., Risley, J. F., Simmons, S., Workowski, K. A. (2017). Sexually transmitted diseases. 44(1), 13-16. doi:10.1097/olq.0000000000000542

Examine factors that facilitate or hinder the implementation of guidelines

• A qualitative study of provider perceptions of influences on uptake of pediatric hospital guidelines in Lao PDR Gray, Amy Z., Soukaloun, D., Soumphonphakdy, B. (2017). Am J Trop Med Hyg. 97(2), 602-610. doi:10.4269/ajtmh.16-1005
• From research to practice: challenges to implementing national diabetes guidelines with five community health centers on the U.S.-Mexico border Schachter, Kenneth A., Cohen, S. J. (2005). Prev Chronic Dis. 2(1), A17.
• An evaluation of the preventing falls and harm from falls in older people best practice guidelines for Australian hospitals: insights into quality, implementability, awareness, and uptake of key recommendations in Australian acute hospitals Barker, Anna. (2013). The Centre of Research Excellence in Patient Safety (CRE-PS), School of Public Health and Preventive Medicine, Monash University.

Examine differences in how health care providers use guidelines

• Project universal preschool vision screening: A demonstration project Hartmann, Eugenie. E., Bradford, G. E., Chaplin, P. K. N., Johnson, T., Kemper, A. R., Kim, S., Marsh-Tootle, W. (2006). American Acadamy of Pediatrics. 117(2), e226-e237. doi:10.1542/peds.2004-2809
• Healthcare professionals' and policy makers' views on implementing a clinical practice guideline of hypertension management: A qualitative study Lee, Ping Yein., Liew, S. M., Abdullah, A., Abdullah, N., Ng, C. J., Hanafi, N. S., Chia, C. Y., Lai, P. S. M., Wong, S. S. L., Khoo, E. M. (2015). PLoS ONE. 10(5). doi:10.1371/journal.pone.0126191
• Feasibility and clinical outcomes when using practice guidelines for evaluation of fever in returning travelers and migrants: a validation study Mueller, Yolanda., D'Acremont, V., Ambresin, A. E., Rossi, I., Martin, O., Burnand, B., Genton, B. (2014). J Travel Med. 21(3), 169-182. doi:10.1111/jtm.12099

Examine clinician adherence to guidelines

• Differences in short-term versus long-term outcomes of older black versus white patients with myocardial infarction: Findings from the can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of American College of Cardiology/American Heart Association Guidelines (CRUSADE) Mathews, Robin., Chen, A., Thomas, L., Wang, T., Chin, C. T., Thomas, K., Roe, Matthew T., Peterson, E. American Heart Association. (2014). Circulation, 130(8), 659-667. doi:10.1161/CIRCULATIONAHA.113.008370
• Clinician agreement, self-efficacy, and adherence with the guidelines for the diagnosis and management of asthma Cloutier, Michelle M., Salo, P. M., Akinbami, L. J., Cohn, R. D., Wilkerson, J. C., Diette, G. B., Williams, S., Elward, K., Mazurek J., Spinner J. R., Mitchell T., Zeldin, D. C. (2018). J Allergy Clin Immunol Pract. 6(3):886-894.e4, 6(3).
• Opioid prescribing in the United States before and after the Centers for Disease Control and Prevention's 2016 opioid guideline Bohnert, Amy S. B., Guy, G. P. Jr., Losby, J. L. (2018). Ann Intern Med. 169(6), 367-375. doi:10.7326/m18-1243

Examine adherence to laboratory and clinical guidelines

• Analytic validation of immunohistochemical assays: A comparison of laboratory practices before and after introduction of an evidence-based guideline Fitzgibbons, P. L., Goldsmith, J. D., Souers, R. J., Fatheree, L. A., Volmar, K. E., Stuart, L. N., Nowak, J., Astles, R., Nakhleh, R. E. (2017). Arch Pathol Lab Med, 141(9), 1247-1254. doi:10.5858/arpa.2016-0558-CP
• Nationwide laboratory adherence to myocardial perfusion imaging radiation dose reduction practices Jerome, Scott. S. D., Tilkemeier, P. L., Farrell, M. B., Shaw, L. J. The American College of Cardiology. (2015).
• Urological referral of asymptomatic men in general practice in England Melia, Juliette., Coulson, P., Coleman, D., Moss, S. (2008). British Journal of Cancer. 98(7), 1176-1181. doi:10.1038/sj.bjc.6604291

Examine trends in adherence to guidelines among specific populations

• Racial/ethnic differences affecting adherence to cancer screening guidelines among women Hirth, Jacqueline. M., Laz, T. H., Rahman, M., Berenson, A. B. (2016). J Womens Health (Larchmt). 25(4), 371-380. doi:10.1089/jwh.2015.5270
• Did CDC's 2006 revised HIV testing recommendations make a difference? Evaluation of HIV testing in the US household population, 2003–2010 Woodring, Joseph., V. D., Kruszon-Moran, D., Oster, A. M., McQuillan, G. M. (2014). JAIDS Journal of Acquired Immune Deficiency Syndromes.
• A longitudinal assessment of adherence to breast and cervical cancer screening recommendations among women with and without intellectual disability Xu, X., McDermott, S. W., Mann, J. R., Hardin, J. W., Deroche, C. B., Carroll, D. D., Courtney-Long, E. A. (2017). Prev Med. 100:167-172., 100.

Examples of approaches, methods, or tools to evaluate guidelines use

• The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) publications archives Glasgow, R. (n.d.). Month: September 1999. Retrieved August 6, 2019.
• Guideline implementability appraisal tool (GLIA) Kashyap, N. (2011). Retrieved August 1, 2019, from http://gem.med.yale.edu/glia/login.htm
• Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., Lowery, J. C. (2009). Implementation Science, 4(1), 50. doi:10.1186/1748-5908-4-50

Author affiliations and disclaimer

Author affiliations:

Melissa Jennings is a Public Health Analyst in the Division of Laboratory Systems; Center for Surveillance, Epidemiology, and Laboratory Services; Centers for Disease Control and Prevention; Atlanta, GA, USA

Goldie MacDonald is the Associate Director for Evaluation in the Center for Surveillance, Epidemiology, and Laboratory Services; Centers for Disease Control and Prevention; Atlanta, GA, USA

Disclaimer:

The findings and conclusions in this guide are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.