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PubMed · 7861105

How to structure clinical practice guidelines for continuous quality improvement?

E A Balas·J Puryear·J A Mitchell·B Barter
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Abstract

The purpose of this study was to evaluate the relevance of available practice guidelines to clinical quality improvement programs. A sample of 19 guidelines was evaluated in four prominent primary care areas. Two research assistants independently coded the clinical conditions and recommended/not recommended procedures abstracted from the guidelines (Cohen's kappa .67 and .50, respectively). An average of 35.1 (+/- 25.8) medical conditions and 48.4 (+/- 41.5) clinical procedures were defined by the guidelines. Most conditions were defined by using ICD-9-CM, age/sex group, or therapy, but 29% of definitions included symptoms which are not coded routinely. CPT codes alone were unable to identify most procedures. AHCPR guidelines mentioned significantly more procedures (p < .001) and fewer symptoms (p < .001) per clinical condition than other guidelines. The difficulty of finding codes for conditions and procedures, the high rate of non-codable items, and the lack of recommended measures limit the applicability of published clinical practice guidelines to continuous quality improvement programs.

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Age FactorsDiagnosisFeasibility StudiesFemaleForms and Records ControlHealth PolicyHumansMaleMedical RecordsMeta-Analysis as TopicModels, StatisticalPractice Guidelines as TopicPrimary Health CareSex FactorsTherapeuticsTotal Quality ManagementUnited StatesUnited States Agency for Healthcare Research and QualityJournal ArticleResearch Support, U.S. Gov't, P.H.S.

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E A Balas, J Puryear, J A Mitchell, B Barter. 1994. How to structure clinical practice guidelines for continuous quality improvement?. https://doi.org/10.1007/bf00996607

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