Accessing the success of implementation of the 2020 Chinese clinical practice guideline for prevention and treatment of type 2 diabetes mellitus in hospitals: a cross-sectional study using A-GIST

Abstract Background Type 2 diabetes mellitus (T2DM) is the leading cause of morbidity and mortality in China. The 2020 Chinese clinical practice guideline for prevention and treatment of T2DM was published at April 2021, yet its status of implementation is unclear. Objective To investigate the success of implementation of the 2020 Chinese clinical practice guideline of prevention and treatment of T2DM in public hospitals in China and to identify its associated factors and barriers. Methods A cross-sectional study was conducted using the data collected from surveillance data from the National Hospital Management and Service Guide Centre of National Health Commission of China. The status of implementation was evaluated using the Guideline Implementation Success Assessment Tool (A-GIST). Descriptive analysis was conducted to explore the status and distribution of guideline implementation among regions, provinces and hospitals, and barriers of implementation. ANOVA test and logistic regression analysis were used to analyze the factors associated with guideline implementation. Significant level was set as 0.05. All statistical analyses were conducted using Stata SE 15. Results In total, 705 participants (365 health professionals and 340 patients) from 26 hospitals and 13 provinces were included. The total implementation score was 76.86 (30.25), ranging from 65.30 to 97.94 among provinces and 42.95 to 97.94 among hospitals. Univariate analysis found that east and west region, senior age, higher degree, physician or pharmacist, senior title, and tertiary hospital had higher total implementation score than their counterparts (p < 0.05). Multivariate regression analysis found middle region (β =-15.71, 95%CI: -24.32, -7.11) and nurse professionals (-16.30, -24.14, -8.45) were independently associated with lower total implementation score. Hospital/department organized learning (69.01%), literature database (53.20%), and academic conference (47.50%) were top 3 routines to access guideline. 43(11.8%) health professionals reported barriers of guideline implementation, among which influence on patient treatment choices (5.2%), impact of medical insurance (6.3%), awareness and familiarity with the guidelines (4.1%), patients’ compliance (8.2%) were top barriers in aspects of guideline-itself, environment, health professional and patient factors. Conclusion The success of implementation of the type 2 diabetes guideline was fair in hospitals in China. There was substantial difference among regions, hospitals, and health professional groups, which warranted improvement. A-GIST is a useful tool for examining the landscape of success of implementation of CPCs and informing the targets and strategies of guideline implementation interventions.