Considerable resources are currently being devoted in the U.S. health care system to develop evidence-based clinical practice guidelines that will assist medical professionals in improving the quality and value of medical care. The health policy community has expressed particular interest in promoting guidelines as a means to reduce social welfare loss associated with unconstrained proliferation of new medical technologies. There is growing recognition, however, that development and dissemination of guidelines often is insufficient to influence practice behavior. Until successful implementation strategies can be developed and understood, efforts to develop scientifically valid guidelines may be largely wasted. This study is a multi-hospital demonstration and evaluation study of an experimental protocol-based strategy for implementing clinical practice guidelines related to radiology contrast agents. If found effective, this approach may have widespread applicability for future use in a number of clinical areas. The evaluation will focus particularly on determining: 1) whether the experimental protocol improves guideline adherence; 2) explaning the impact of organizational factors on adherence; and 3) investigating the role of market competition andprice responsiveness in explaining guideline adherence. To accomplish these aims, I am expanding the scope of an ongoing randomized controlled trial involving 25 New York City area hospital. Adherence will be measured using institutional-level utilization data regarding contrast agents. Analysis willuse mulivariate logistic regression techniuqes to determine whether the intervention improves adherence and idenntify important predictors. This analysis will be integrated with a supplemental analysis of pharmaceutical market data to specifically investigate the role of prices on demand behavior. A comparative case study also will be conducted to better understand organizational characteristics and processes that explain adherence.
