Clinical Practice Guidelines

Clinical practice guidelines are increasingly being used in the United States to reduce inappropriate care and improve patient outcomes. Several factors are fueling the use of guidelines, including the increasing costs of healthcare, new medical technology, a growing aging population, and variations in the service delivery of care by physicians, hospitals, and geographic regions. Clinical practice guidelines are broadly defined as statements that are systematically developed to assist clinicians and patients in making decisions about appropriate healthcare, given specific clinical conditions. Specifically, the major purposes for guidelines include the following: (a) assisting patients and practitioners in making clinical decisions, (b) educating individuals and groups, (c) assessing to ensure the quality of healthcare, (d) providing guidance for allocation of resources, and (e) reducing liability risk in cases of negligent care.

Primarily, clinical practice guidelines are of most value to healthcare practitioners, patients and their families, and healthcare institutions. In an effort to contain healthcare costs, public policymakers, health benefit plans, and regulators may find them useful when making specific decisions [Page 175]about reimbursement. For patients, a consumer version of guidelines made available through leaflets, audiotapes, videos, magazines, newspapers, and Web sites provides a summary of the benefits and harm regarding healthcare options and potential outcomes. Guidelines empower patients to become more educated consumers, active in choices about their own health. Guidelines may also help the patient by calling attention to the need for changes in public policy regarding issues such as preventive interventions to assist neglected or high-risk groups or other areas requiring increased attention. For healthcare providers, guidelines can improve the quality of clinical decisions by providing clear directions on how to proceed with an intervention, keeping clinicians updated, improving consistency of care, and providing an authoritative base for decision making. Healthcare organizations may primarily benefit from guidelines by minimizing costs and optimizing the value of money spent through the greater standardization of care.

Despite all the perceived benefits, clinical practice guidelines have their limits. Recommendations may not apply readily to an individual patient, requiring clinicians to tailor decisions based on the patient's unique medical history and personal circumstances. Guidelines may also influence policymakers to refuse to pay for certain services. In terms of their development, guidelines may be flawed due to a lack of adequate scientific evidence, inadequate evaluation of study design flaws, the bias of the group that developed the guidelines, or a bias in favor of serving the needs of payers or special interests groups rather than with the patient's best interest. In weighing their advantages and disadvantages, guidelines may be best viewed as one option for improving the quality of healthcare.

The development of clinical practice guidelines involves three basic stages: (1) development, (2) implementation, and (3) evaluation. This process or cycle is dynamic in that the implementation and evaluation stages prompt periodic revisions when they become outdated due to new scientific evidence, when omissions are found, or when other problems are identified. Historically, most of the focus has been on the development phase. In more recent years, however, the last two stages have received growing attention.

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