Effects of evidence-based clinical practice guidelines for COVID-19 in health care quality improvements. A third systematic review.

Abstract

Background Historically, Evidence-Based Clinical Practice Guidelines were thought to primarily enhance healthcare consistency and quality. However, this claim requires conclusive confirmation. We employed the Donabedian model encompassing three dimensions, patient outcomes, process, and structure, to evaluate the use of EB-CPGs and their potential healthcare improvements. This represents our third systematic review within a series exploring significant pathologies. The overarching goal is to assess the effectiveness of EB-CPGs to enhance care quality. Methods Following the methodology of the Manual of Cochrane, a descriptive analysis was performed due to considerable heterogeneity in the included studies. Searches were carried out from 2019 to May 2023 across databases including EMBASE, PubMed, OVID, Cochrane Central RCT, and grey literature. No limitations were imposed on language. We selected only randomised controlled trials (RCTs). Results Across the fifteen evaluated RCTs, 220 interventions were examined. Of these, 6 (3%) were associated with structure, while 136 (62%) focused on the healthcare delivery process, and 78 (35%) targeted patient health outcomes. No significant differences were identified between the compared groups in 155 interventions (71%) regarding the implementation of EB-CPGs. In 27 interventions (12%), the outcome benefited the control group, while the intervention group demonstrated favourable outcomes in 38 (17%). Conclusions Our research revealed slight quality improvement in healthcare through EB-CPGs in patient outcomes and healthcare processes. Neutral results suggest no clear advantage among groups. In future studies, it would be necessary to enhance both the design and methodological rigour of RCTs and to consider in their analysis the strength of the recommendations included in the EB-CPGs along with their respective levels of evidence certainty. This would enable more precise hypotheses to be established regarding the reasons behind these findings. PROSPERO registration CRD42022354708.