2 31 Implementation strategies used to implement nursing guidelines in daily practice compared two implementation strategies (external facilitation and education outreach visits) in order to introduce nutritional guidelines. Besides no differences in nutritional parameters after 18 months, they found significant deteriorations for functional and cognitive status, as well as for the EQ-5D index (quality of life questionnaire), (p<0.05) in the intervention group that received educational outreach visits. Ten of the controlled studies (n=15) measured patient-related nursing outcomes. Six found a significant positive effect; four found no effect. Twenty-two of the beforeafter studies (n=37) measured patient-related nursing outcomes. Thirteen found a significant positive effect, seven found no significant effect (n=7), and two performed no statistical tests (n=2). When comparing the controlled and before-after studies, we found no significant difference between these groups on reported significant change in patient-related nursing outcomes (p≥0.05). Relative change percentage on the patient-related nursing outcomes All relative change are shown in Supplement 6 Relative change percentage in the controlled studies on the patient-related nursing outcomes and Supplement 7 Relative change percentage in the before-after studies on the patient-related nursing outcomes. The median relative change measuring patient-related nursing outcomes was 2.7% (IQR 1.0– 40.6) for the controlled studies (n=10), and 22.1% (IQR 8.7 – 81.4) for the beforeafter studies (n=19). This differed significantly between the controlled and before-after groups (p=0.009). The scatterplots for the controlled (figure 2) and before-after (figure 3) studies show that there was no association between the total number of used strategies and the relative change on the patient-related nursing outcomes. For the controlled studies the slope suggests that using more strategies, will result in a lower relative change. However, the sample is too small to conclude this (n=10). The median relative change for studies that used strategies from the EPOC category implementation strategies alone was 13.8% (IQR 3.6-81.9). For the studies that used a combination of strategies from the EPOC categories the median was 20.1% (IQR 3.267.3), however this was not statistically different (p=0.95).
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