EVALUATING THE MESSAGE - THE RELATIONSHIP BETWEEN COMPLIANCE RATE ANDTHE SUBJECT OF A PRACTICE GUIDELINE

To explore the relationship between providers' compliance and some key aspects of the clinical messages in practice guidelines, studies publ ished in the English language medical literature between 1980 and 1991 were retrieved through MEDLINE and through relevant review articles i n the field. All published studies providing compliance rates with pra ctice guidelines and endorsed by official organizations were eligible for the study. The clinical content and the reported compliance, rate were gathered for each recommendation in the 23 studies selected. The medical and surgical procedures addressed by 143 recommendations were identified according to specialty area, type of procedure (diagnostic, surgical, etc.) and were independently classified by the authors as b eing high or low on characteristics thought to influence diffusion: co mplexity, trialability and observability. The mean compliance rate wit h the 143 clinical recommendations was 54.5% (95% CI: 50.2%-58.9%), wi th those in the specialty areas of cardiology and oncology showing the highest compliance (mean 63.6% and 62.2%, respectively). Recommendati ons concerning procedures with high complexity had lower compliance ra tes than those low on complexity (41.9% vs. 55.9%; P =0.05), and those judged to be high on trial ability had higher compliance rates than t hose low on trialability (55.6% vs 36.8%; P =0.03). Overall, all the c haracteristics of the clinical recommendations considered in the pract ice guidelines could account for no more than 47% of the observed vari ability in compliance rates. The target area of practice and the compl exity and trialability of the recommended procedure appear to be usefu l, if partial, predictors of the level of compliance with a practice g uideline.