ABSTRACT
Over the past several decades, there has been a dramatic rise in the number of clinical guidelines (1), especially those “evidence-based guidelines” that make the link to the best scientific evidence both consistent and explicit (2, 3). Yet, establishing standards is but the first step in improving medical practice. Research indicates that simply making providers aware of a clinical guideline is a disappointingly weak strategy for inducing adherence with clinical guidelines. This holds true for continuing medical education (CME), printed educational materials, and academic detailing using opinion leaders (4-9). (See 13 for more details on opinion leaders.) Such strategies can be successful in encouraging providers to want to change, but unless the system of care is modified in a way that helps them to act on these new beliefs, permanent change is unlikely.
