Evidence for the effectiveness of techniques to change physician behavior

Study objectives: To understand the theory and results of how to improve ph ysician performance, as part of overall health-care quality improvement. In particular to study whether and how guideline production and dissemination affects physician performance. Design: Review of meta-analyses and structured reviews; review of behavior change theories implicit in interventions to change physician performance. Setting: Primarily the United States. Patients or participants: Various patients and physicians, determined by re views. Interventions: None. Measurements and results: There is no unifying theory of physician behavior change tested among physicians in practice. Attempts to affect individual physicians' performance have often met with failure. Mixed results are foun d for almost all interventions reviewed, Multiple interventions yield bette r results. Conclusions: The answer to the question of what works to improve an individ ual physician's clinical performance is not simple, Emerging theory and evi dence suggests that applications of behavior-change methods should not be f ocused on which tools (don't) always work. Instead, guideline development a nd implementation methods should be theory driven and evidence based (suppo rted by evidence that proves the theory correct). In particular, the framew ork of evidence-based quality assessment offers some insight into past fail ures and offers hope for organizing attempts at guideline implementation.