Complex professional interventions improved the process of care , but the effect on patient outcomes remained less clear because such outcomes were rarely assessed .
Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures .
Complex interventions in which patient education was added and /or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care .
CONCLUSIONS Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care .
The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care
No magic bullets: a systematic review of 102 trials of interventions to improve professional practice.
OBJECTIVE To determine the effectiveness of different types of interventions in improving  health professional performance and health outcomes . DATA SOURCES MEDLINE , SCI SEARCH , CINAHL and the Research and Development Re source Base in CME were search ed for trials of  educational interventions in the health care professions published between 1970 and 1993 inclusive . STUDY SELECTION Studies were selected if they provided objective measurements of  health professional performance or health outcomes  and employed r and om or quasi-r and om allocation methods in their study design s to assign individual subjects or groups . Interventions included such activities as conferences , outreach visits , the use of local opinion leaders , audit and feedback , and reminder systems . DATA EXTRACTION Details extracted from the studies included the study design ; the unit of allocation ( e.g. , patient , provider , practice , hospital ) ; the characteristics of the targeted health care professionals , educational interventions and patients ( when appropriate ) ; and the main outcome measure . DATA SYNTHESIS The inclusion criteria were met by 102 trials . Areas of behaviour change included general patient management , preventive services , prescribing practice s , treatment of specific conditions such as hypertension or diabetes , and diagnostic service or hospital utilization . Dissemination-only strategies , such as conferences or the mailing of unsolicited material s , demonstrated little or no changes in health professional behaviour or health outcome when used alone . More complex interventions , such as the use of outreach visits or local opinion leaders , ranged from ineffective to highly effective but were most often moderately effective ( result ing in reductions of 20 % to 50 % in the incidence of inappropriate performance ) . CONCLUSION There are no " magic bullets " for improving the quality of health care , but there are a wide range of interventions available that , if used appropriately , could lead to important improvements in professional practice and patient outcomes
Complex professional interventions improved the process of care , but the effect on patient outcomes remained less clear because such outcomes were rarely assessed .
Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures .
Complex interventions in which patient education was added and /or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care .
CONCLUSIONS Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care .
The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care