Background: The effectiveness of clinical practice guidelines(CPG) as a strategy to change and improve care remains uncertain. Objective: To assess whether familiarity with American Academy of Pediatrics (AAP) CPGs in general, and with the AAP hyperbilirubinemia CPG in particular, is associated with knowledge of the assessment and treatment(including follow-up) of hyperbilirubinemia. Design: Written survey of clinicians at six sites, representing two pediatric emergency departments(ED), two hospital-based practices (HBP), and two office-based private practices (PP). Outcome measure: Percent of questions answered correctly about the assessment (19), treatment and follow-up (7), and overall knowledge (mean of the two subscores) of hyperbilirubinemia. Independent measures: Years since graduation, involvement in quality improvement (QI) activities, attitudes toward CPGs, familiarity with AAP CPGs, familiarity with the AAP hyperbilirubinemia CPG, practice type, provider type(attending, fellow, resident, and nurse practitioner) and experience with newborns. Results: Of 233 eligible clinicians, 186 (79.8%) responded. 42% of clinicians reported familiarity with the AAP hyperbilirubinemia CPG (65% of PP clinicians, 57% of ED clinicians, and 35% of HBP clinicians). Clinicians reporting familiarity with the hyperbilirubinemia CPG achieved higher scores on overall knowledge (p=0.0006) and treatment(p=0.0019). No other independent measure was associated with overall knowledge. After controlling for all other independent measures, familiarity with the AAP hyperbilirubinemia CPG remained associated with overall knowledge(p=0.0066). Assessment score was related to practice (p=0.0001) and provider(p=0.0060) type, while treatment score was related to provider type (p=0.03) as well as familiarity with the AAP hyperbilirubinemia CPG. Conclusions: Reported familiarity with the AAP hyperbilirubinemia CPG is associated with increased knowledge. The findings that knowledge subscores varied by provider and practice type suggest that CPG dissemination and educational approaches should be tailored to particular practice settings. Additional study should also examine whether knowledge relates to actual clinical practice.
