Impact of Guideline Implementation on Patient Care: a Cluster RCT

Mettes, T.G.P.H.; Sanden, W.J.M. van der; Bronkhorst, Ewald M.; Grol, Richard; Wensing, Michel; Plasschaert, A.J.M.

doi:10.1177/0022034509350971

Cited by 19 publications

(18 citation statements)

References 31 publications

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“…However, while such quality management programs are available for dental care, evidence on their impact and effectiveness is sparse [6], with some exceptions [15,16]. There is an urgent need for validated quality assessment tools for dental care [7].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a quality management program in dental care practices

Goetz

Campbell

Broge³

et al. 2014

BMC Oral Health

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BackgroundStructured quality management is an important aspect for improving patient dental care outcomes, but reliable evidence to validate effects is lacking. We aimed to examine the effectiveness of a quality management program in primary dental care settings in Germany.MethodsThis was an exploratory study with a before-after-design. 45 dental care practices that had completed the European Practice Assessment (EPA) accreditation scheme twice (intervention group) were selected for the study. The mean interval between the before and after assessment was 36 months. The comparison group comprised of 56 dental practices that had undergone their first assessment simultaneously with follow-up assessment in the intervention group. Aggregated scores for five EPA domains: ‘infrastructure’, ‘information’, ‘finance’, ‘quality and safety’ and ‘people’ were calculated.ResultsIn the intervention group, small non-significant improvements were found in the EPA domains. At follow-up, the intervention group had higher scores on EPA domains as compared with the comparison group (range of differences was 4.2 to 10.8 across domains). These differences were all significant in regression analyses, which controlled for relevant dental practice characteristics.ConclusionsDental care practices that implemented a quality management program had better organizational quality in contrast to a comparison group. This may reflect both improvements in the intervention group and a selection effect of dental practices volunteering for the first round of EPA practice assessment.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of a quality management program in dental care practices

Goetz

Campbell

Broge³

et al. 2014

BMC Oral Health

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“…In implementing guidelines, various multifaceted strategies have been considered to tailor implementation to the individual setting [ 2 , 9 , 15 – 22 ]. In this study, the implementation was by way of interactive seminars with discussion and dissemination of the published guidelines in print and electronic forms.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the impact of caries prevention and management by caries risk assessment guidelines on clinical practice in a dental teaching hospital

2016

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BackgroundClinical practice guidelines on ‘Dental caries prevention and management by caries risk assessment for pre-school children in Hong Kong’ were developed using ADAPTE process and Delphi consensus technique. This study aimed to evaluate the feasibility of disseminating and implementing the guidelines, and to evaluate their effectiveness in changing clinical practice.MethodsThe study was conducted in two phases, examining clinical records of pre-school aged patients being treated by non-academic clinical staff in the Paediatric Dentistry Clinic of a dental teaching hospital in Hong Kong. The clinical guidelines were introduced to the staff in a departmental seminar at the end of pre-intervention phase. Post-intervention phase began one month after the introduction of guidelines. Clinical records for three consecutive months were reviewed against standards and recommendations derived from the newly developed clinical guidelines in both phases. The results were assessed by Chi-square test, ANOVA and regression analyses.ResultsA total of 237 and 147 clinical records were reviewed in pre-intervention and post-intervention phases, respectively. Guideline adherence percentage increased significantly on almost all aspects of the guidelines in the post-intervention phase (P < 0.05). There were a significant difference in the mean overall guideline adherence score (pre-intervention phase: = 14.86 ± 6.11; post-intervention phase: = 28.88 ± 8.75) and sub-domain adherence scores between the two phases (P < 0.001). The training grade of the clinicians was the factor associated with changes in evidence-based practice (P < 0.001).ConclusionsThe developed guidelines were effective in translating evidence into best practice. The findings have implication for widespread implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-016-0217-9) contains supplementary material, which is available to authorized users.

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“…9 The reliance on passive methods to disseminate evidencebased guidelines has resulted in limited adoption of these guidelines in clinical care. [10][11][12] Active strategies to implement evidence-based treatment guidelines are more likely to promote change in practice behavior. 12 Case-based simulations are powerful active strategies that have the potential to enhance learning and drive behavior change.…”

Section: Introductionmentioning

confidence: 99%

Dental Decision Simulation (DDSim): Development of a virtual training environment

Johnson

Schmidt

Bader

et al. 2020

Journal of Dental Education

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Case-based simulations are powerful training tools that can enhance learning and drive behavior change. This is an overview of the design/development of Dental Decision Simulation (DDSim), a web-based simulation of an electronic dental record (EDR). The purpose was to use DDSim to train dentists to make evidence-based treatment planning decisions consistent with current evidence. This simulated EDR provides case-based information in support of a set of defined evidence-based learning objectives. Methods: The development of this complex simulation model required coordinated efforts to create several components: identify behavior changes, case authoring mechanism, create virtual patient visits, require users to make treatment plan decisions related to learning objectives, and a feedback mechanism to help users recognize departures from those learning objectives. This simulation was evaluated in a 2-arm, clinic-randomized, controlled pilot study examining the extent to which DDSim changed dentists' planned treatment to conform to evidence-based treatment guidelines relative to change in dentists not exposed to DDSim. Outcomes were measured by comparing preintervention and postintervention patient EDR treatment data. Results: Changes in behavior over time did not favor intervention or control clinics. Conclusion: DDSim provides a standardized learning platform that cannot be achieved through the use of live patients. Both live patients and case-based simulations can be used to transfer knowledge and skill development. DDSim offers 1284

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Impact of Guideline Implementation on Patient Care: a Cluster RCT

Cited by 19 publications

References 31 publications

Effectiveness of a quality management program in dental care practices

Effectiveness of a quality management program in dental care practices

Evaluating the impact of caries prevention and management by caries risk assessment guidelines on clinical practice in a dental teaching hospital

Dental Decision Simulation (DDSim): Development of a virtual training environment

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