Educational spillover effect within a cluster: Impact of guideline education for schizophrenia and major depressive disorder on psychiatrists' treatment behavior in a real-world multicenter study.
Educational interventions can influence not only individuals who directly receive them but also nonparticipating individuals within the same cluster. This study examined whether an educational spillover effect within a cluster occurs during real-world implementation of clinical practice guidelines.
Discharge data for inpatients with schizophrenia (n = 22,032) and major depressive disorder (MDD) (n = 11,207) from 298 facilities among those participating in the Effectiveness of GUIdeline for Dissemination and Education in psychiatric treatment (EGUIDE) project between 2016 and 2024. Patients were categorized into three groups based on psychiatrist participation and facility participation: Group 1 (psychiatrist[-], facility[-]), Group 2 (psychiatrist[-], facility[+]), and Group 3 (psychiatrist[+], facility[+]). Primary outcomes were implementation rates of guideline-recommended treatments (Quality Indicators: QIs). The EGUIDE training effect was modeled as an ordinal variable (Group 1 < Group 2 < Group 3). Logistic regression adjusted for age, sex, and facility type was used to estimate Odds Ratios (ORs).
Significant positive associations were observed for 9 of 11 QIs in schizophrenia and 5 of 7 QIs in MDD (e.g., QI-S1: assessment of treatment-resistant schizophrenia diagnosis, adjusted OR 1.98, P < 2.78 × 10-192). Guideline adherence increased sequentially from Group 1 to Group 3.
This study was the first to empirically demonstrate, in a non-randomized real-world setting, that educational spillover effects extended beyond participating psychiatrists to influence nonparticipating psychiatrists within the same facility. These findings underscore the importance of leveraging facility-level spillover effects in guideline implementation strategies.
Discharge data for inpatients with schizophrenia (n = 22,032) and major depressive disorder (MDD) (n = 11,207) from 298 facilities among those participating in the Effectiveness of GUIdeline for Dissemination and Education in psychiatric treatment (EGUIDE) project between 2016 and 2024. Patients were categorized into three groups based on psychiatrist participation and facility participation: Group 1 (psychiatrist[-], facility[-]), Group 2 (psychiatrist[-], facility[+]), and Group 3 (psychiatrist[+], facility[+]). Primary outcomes were implementation rates of guideline-recommended treatments (Quality Indicators: QIs). The EGUIDE training effect was modeled as an ordinal variable (Group 1 < Group 2 < Group 3). Logistic regression adjusted for age, sex, and facility type was used to estimate Odds Ratios (ORs).
Significant positive associations were observed for 9 of 11 QIs in schizophrenia and 5 of 7 QIs in MDD (e.g., QI-S1: assessment of treatment-resistant schizophrenia diagnosis, adjusted OR 1.98, P < 2.78 × 10-192). Guideline adherence increased sequentially from Group 1 to Group 3.
This study was the first to empirically demonstrate, in a non-randomized real-world setting, that educational spillover effects extended beyond participating psychiatrists to influence nonparticipating psychiatrists within the same facility. These findings underscore the importance of leveraging facility-level spillover effects in guideline implementation strategies.
Authors
Horinouchi Horinouchi, Arai Arai, Hasegawa Hasegawa, Muraoka Muraoka, Yamamuro Yamamuro, Hashimoto Hashimoto, Kawamata Kawamata, Ochi Ochi, Ohi Ohi, Hori Hori, Yasuda Yasuda, Kodaka Kodaka, Tsuboi Tsuboi, Watanabe Watanabe, Yamada Yamada, Onitsuka Onitsuka, Ichihashi Ichihashi, Matsumoto Matsumoto, Numata Numata, Inada Inada, Yasui-Furukori Yasui-Furukori, Hashimoto Hashimoto
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