Guidelines in diagnostics: formulation methodology proposal.

Abstract

In healthcare the term "guideline" is used in numerous circumstances and for different purposes. The most commonly accepted definition is provided by the American Agency for Healthcare Research and Quality, which defines guidelines as "recommendations developed in order to assist doctors and patients in the decision-making process, while choosing an appropriate assistance in specific clinical circumstances". At present, in Italy and foreign countries, guidelines are considered an effective tool. Guidelines contribute with a qualitative improvement in performances, standardizing healthcare criteria, enabling also rationalisation and optimisation in both human and economical resources. The achievement of these aims depends on a thorough examination of both meaning and role played by guidelines in clinical practice, and of the essential methodological criteria of their processing. Unfortunately, these objectives can be attained only after the overcoming of obstacles, due to both limits in the formulation of such documents (use of inadequate methodology, choice of the paper-based collection of documents rather than computer-based data-processing support), and to the opposition of the medical personnel. The latter problem being caused by a poor knowledge of the role played by guidelines and by the difficulty of a critical evaluation of their validity. In fact, the success of a guideline is also determined by its development, implementation and introduction strategies, and by the consence of the medical community. Once formulated by an interdisciplinary group of experts, a guideline should be necessarily revised according to already coded procedures. A reliable contribution to the diffusion of such guidelines derives from the use of computer-based data-processing supports, which contribute to their interactivity, user friendliness, user-adaptivity and updatebility. The above illustrated procedures represent an unquestionable contribution to the clinical decision-making process. In fact, these represent the basic development tools for the harmonisation of cultural qualification and clinical practice, aiming at quality improvement and rationalisation in health-related activities.