K O Murrey | PubMed Health

PubMed1992

Implementing clinical guidelines: a quality management approach to reminder systems.

"Reminders" (timely notices about specific clinical events to physicians or patients) are useful strategies for implementing clinical guidelines. These systems can vary widely in content, design, and purpose. This variability makes it difficult to compare systems or predict a reminder's efficacy in a particular setting. In this article, the authors suggest that too much attention has been paid to proving the efficacy of reminder systems as a general strategy or a comprehensive solution. Rather, the usefulness and effectiveness of reminder systems will be better appreciated when quality management principles are applied to designing, implementing, and maintaining them. Physicians must participate in finding the best solutions for clinical process problems, and reminder systems--when implemented as the "best solution"--must be monitored and improved continually on an ongoing basis to continue to meet physicians' needs.

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PubMed1992

Algorithm-based clinical quality improvement. Clinical guidelines and continuous quality improvement.

Evidence documenting unexplained variation in clinical practices and outcomes has led to a proliferation of clinical practice guidelines in the hope that such efforts will lead to decreased variation, improved care, better outcomes, and lower costs. At Harvard Community Health Plan we have developed a clinical guideline development effort that focuses on the development of clinical algorithms and guidelines in a quality improvement model. The formal quality improvement process that we have described requires; (1) clear project definition and organization, (2) guideline development based on an understanding of patient needs, scientific evidence and clinical experience, (3) thorough analysis of potential problems with active implementation efforts, and (4) measurement and evaluation of results. By incorporating clinical guideline development into a quality improvement model and integrating such efforts with a total quality management strategy, we can substantially increase the likelihood of successfully implementing clinical practice guidelines and improving the quality of care that we deliver.

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