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At least 217 records · Page 12Linked to original sources
PubMed2002

[The Dutch College of General Practitioners' practice guideline, "Vaginal bleeding"; reaction from a general practice perspective].

The most important changes in the first revised version of the Dutch College of General Practitioners' practice guideline 'Vaginal bleeding' are the passages about the progesterone-containing 'intra-uterine device' (IUD), the combination of progesterone and oestrogen by prescribing, for example, a sub-50-pill for the treatment of menorrhagia, and advising the patient to undergo a transvaginal ultrasound to determine the amount of build-up in the endometrium. Vacuum aspiration of the endometrium to establish the cause of menorrhagia is not mentioned. This first revised version can contribute to the quality of care in general practice.

Female↗
PubMedDate not supplied

Translating psychosocial research findings into practice guidelines.

Evidence-based practice guidelines are increasingly used by healthcare professionals to guide patient care and effect positive patient outcomes. These guidelines are usually based on laboratory-based parameters and lack the psychosocial dimensions of patient care. The authors describe the process used by a hospital-based interdisciplinary team to successfully develop evidence-based psychosocial guidelines designed to foster hopefulness in pediatric patients with cancer, their families, and their healthcare providers. From these guidelines, 4 clinical care projects were developed and are described in this article.

Adolescent↗
PubMedDate not supplied

Outcomes from use of an evidence-based practice guideline.

The aim of evidence-based guidelines is primarily to improve patient outcomes without adding to the existing cost of care because both payers and policymakers want to identify health care costs that do not result in benefit to the patient. The purpose of the reported project was to generate a practice guideline for the treatment of uncomplicated acute cystitis in a female population, to determine the extent to which the guideline would be used by providers and to measure the cost and quality of outcomes from its use. A retrospective chart review was used to gather pre-guideline practice and cost data. Measurements included the type, frequency, and duration of antibiotic therapy and the use of urine cultures and both complications and routine followup visits. The implementation of an outpatient practice guideline resulted in a significant change in antibiotic prescribing and a trend toward a change in ordering cultures and clinic followup. There was also a significant decrease in treatment costs.

Acute Disease↗
PubMedDate not supplied

A review of quantitative studies of adherence to mental health clinical practice guidelines.

Mental health clinical practice guidelines have proliferated, but there is little evidence regarding the degree to which they are actually implemented in clinical practice. The goal of this study was to locate and review all peer-reviewed reports published through 2000 that provide quantitative information on rates of adherence to specific mental health guidelines. A literature search yielded 41 pertinent studies. These studies were of three types: 26 were cross-sectional investigations performed after the release of guidelines, six were conducted before and after release of guidelines without any specific intervention (pre/post), and nine involved a controlled trial of a specific intervention. Only 37% were conducted in the mental health specialty sector. Adequate adherence was found in 27% of the cross-sectional and pre/post studies but in 67% of the controlled trials. Successful interventions tended to be complex, involving system redesign or additional resources. Only six of 13 investigations (46%) that also measured patient outcome found that better outcome was associated with greater guideline adherence. Several studies showed that after cessation of interventions, adherence rates returned to preintervention levels. Thus, evidence indicates that guideline adherence is not high without specific intervention, but that certain interventions (typically multifaceted and resource-intensive ones) improve adherence. However, the public health challenge is to design and implement interventions that are sustainable in general clinical practice.

Attitude of Health Personnel↗
PubMed1999

The cost of implementing the Dialysis Outcomes Quality Initiative Clinical Practice Guidelines.

For a clinical practice guideline to be accepted by the end-user, the system of reimbursement for the targeted service must be favorable. The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Guideline recommendations were developed without primary concern for the costs of their execution. Arguably, an unfavorable financial environment and excessive mercantile behavior by providers and payers would offer a considerable hindrance to their implementation. Toward addressing these concerns, three leaders in the development of the DOQI Guidelines for the Treatment of Anemia of Chronic Renal Failure, Hemodialysis Adequacy, and Vascular Access, have evaluated the hypothesis that implementing the recommendations of the DOQI Guidelines will increase the treatment costs for dialysis providers but will effect savings in the entire end-stage renal disease (ESRD) program. Their analyses suggest that under the current reimbursement system, this assumption may be true. However, restructured global reimbursement in the ESRD program will permit financial incentives for dialysis providers and the payer to coincide.

Anemia↗
PubMed2003

[Feeding of infants based on age. Practice guidelines].

This paper presents practical guidelines for nutrition and feeding of infants and toddlers including vitamin D, vitamin K and fluoride supplementations and preventive measures at risk for food allergy based on family history.

Breast Feeding↗
PubMed1998

Clinical practice guidelines and their role in quality of care assessments.

Clinical practice guidelines may be defined as systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical conditions. The practice guideline is a management plan that enables healthcare providers to make sequential decisions about testing or therapy in a given clinical situation. Given the heterogeneity of disease presentations and the complexity of making therapeutic decisions, the development of guidelines in neurosurgery presents unique problems and challenges. Clinical practice guidelines were developed in part as a method for the assessment of quality of medical care processes. Practice guidelines serve as a tool for comparisons to be made within and between healthcare delivery systems. The implementation of guidelines also allows for the acquisition of clinical and financial data that provide for outcomes analysis and other types of information. The characterization of patterns of care in different institutions and the relationship between patterns of care and outcomes will in the future allow for quality improvement, enable physicians to offer predictability and accountability to third-party interests, and contribute to an understanding of how to offer the best care to neurosurgical patients. The author provides an overview of clinical practice guidelines and illustrates their role in the assessment of quality of patient care, demonstrates how they fit into the methodology of quality assessments, and underscores the importances of practice quidelines for the development of disease management systems.

Journal Article↗
PubMed2002

Practice guidelines and performance measures in emergency medical services for children.

Practice guidelines and performance measures are critical elements of an effective quality improvement process for emergency medical services for children (EMSC). Practice guidelines address the clinical management of individual patients, and performance measures assess the quality of care delivered to a population. The public and private sectors have invested considerable resources in developing practice guidelines and performance measures to improve the quality of health care services. As organizations continue development efforts, health care professionals who are actively involved in emergency care must collaborate to develop guidelines that address the unique physiologic, psychologic, and cultural needs of children. The Emergency Medical Services for Children Managed Care Task Force recommended the development of a series of white papers to focus on issues related to practice guidelines and performance measures in EMSC. The Maternal and Child Health Bureau, Health Resources and Services Administration, the National Highway Traffic Safety Administration, and the Robert Wood Johnson Foundation jointly sponsored the project. The paper was developed by a panel selected from a pool of experts in managed care, quality improvement, and emergency medical services. After a review of the literature, the panelists met to discuss critical issues related to practice guidelines and performance measures in EMSC. The panelists developed recommendations that can serve as resources for managed care organizations, health care providers, professional associations, and governmental policy makers. The panel recognized the lack of nationally recognized pediatric emergency care guidelines and performance measures and called for immediate action in these areas.

Child↗
PubMed1993

Automated linkage of free-text descriptions of patients with a practice guideline.

The process of applying a practice guideline to a patient requires a great deal of clinical data. AAPT (Appropriateness-Assessment Processing from Text) is an experimental computer program that can assess the appropriateness of coronary-artery bypass grafting surgery (CABG) in patients with coronary-artery disease (CAD) and chronic stable angina from the admission summaries of those patients. The AAPT architecture combines natural-language processing (NLP) and probabilistic inference. The NLP module identifies single clinical concepts of interest in the free-text document. The probabilistic inference module, a Bayesian belief network, estimates values for variables not specifically mentioned. AAPT produces a patient's summary of CAD that is similar to a manually generated clinical summary. Work is ongoing to improve AAPT and evaluate it as a tool to assist in the dissemination of guidelines and as a tool to encourage adherence to practice guidelines.

Angina Pectoris↗
PubMed2003

Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project.

BACKGROUND: International interest in clinical practice guidelines has never been greater but many published guidelines do not meet the basic quality requirements. There have been renewed calls for validated criteria to assess the quality of guidelines. OBJECTIVE: To develop and validate an international instrument for assessing the quality of the process and reporting of clinical practice guideline development. METHODS: The instrument was developed through a multi-staged process of item generation, selection and scaling, field testing, and refinement procedures. 100 guidelines selected from 11 participating countries were evaluated independently by 194 appraisers with the instrument. Following refinement the instrument was further field tested on three guidelines per country by a new set of 70 appraisers. RESULTS: The final version of the instrument contained 23 items grouped into six quality domains with a 4 point Likert scale to score each item (scope and purpose, stakeholder involvement, rigour of development, clarity and presentation, applicability, editorial independence). 95% of appraisers found the instrument useful for assessing guidelines. Reliability was acceptable for most domains (Cronbach's alpha 0.64-0.88). Guidelines produced as part of an established guideline programme had significantly higher scores on editorial independence and, after the publication of a national policy, had significantly higher quality scores on rigour of development (p<0.005). Guidelines with technical documentation had higher scores on that domain (p<0.0001). CONCLUSIONS: This is the first time an appraisal instrument for clinical practice guidelines has been developed and tested internationally. The instrument is sensitive to differences in important aspects of guidelines and can be used consistently and easily by a wide range of professionals from different backgrounds. The adoption of common standards should improve the consistency and quality of the reporting of guideline development worldwide and provide a framework to encourage international comparison of clinical practice guidelines.

Europe↗
PubMed2003

Lying in the bed we've made: reflection on some unintended consequences of clinical practice guidelines in the courts.

Evidence on the use of clinical practice guidelines to aid in the legal determination of negligence is increasing, specifically where they affect determinations of the standard of care and causation. So too is evidence that some clinical practice guidelines are of poor quality. An action alleging the negligent failure to diagnose and treat gestational diabetes in 1988, in which the neonate suffered permanent brachial plexus injury, entered into evidence a 1984 clinical practice guideline authored by the Society of Obstetricians and Gynaecologists of Canada. No "experts" were called to adjudicate the quality of this guideline, which cited no evidence or rationale in support of its recommendations. The standard as laid out in the guideline was judged by the court to reflect a prevailing standard of care, and a finding of negligence was rendered. As the courts pay increased attention to clinical practice guidelines, critical appraisal by the professional organizations developing these documents must occur to assure methodological rigour. Further, the quality of clinical practice guidelines should receive critical scrutiny by the courts if they are to be relied upon, even partially, to assist with legal determinations of the standard of care or issues under causation.

Brachial Plexus↗
PubMed1994

Clinical practice guidelines for managing major depression in primary care practice. Implications for psychologists. U.S. Public Health Service Agency for Health Care Policy and Research.

Clinical practice guidelines are being developed by professional and governmental bodies to improve the quality of health care. The guidelines developed by the U.S. Public Health Service Agency for Health Care Policy and Research seek to improve the primary care physician's ability to diagnose and treat major depression. Clinical, educational, and research implications for psychologists are considered in light of how the recommended guidelines potentially will influence the nature and quality of care provided for mood disorders by generalist physicians.

Antidepressive Agents↗
PubMed2000

Practical guidelines for vancomycin usage, with prospective drug-utilization evaluation.

To strengthen guidelines for vancomycin use, practical guidelines were developed. A prospective survey was conducted of all patients receiving vancomycin during two 1-month periods, 1 year apart, during which significant improvements were noted. Practical guidelines may contribute to appropriateness of vancomycin use, serve as educational tools, and facilitate improved surveillance.

Drug Utilization Review↗
PubMed1999

Clinical practice guidelines in unstable angina improve clinical outcomes by assuring early intensive medical treatment.

OBJECTIVES: To determine the influence of clinical practice guidelines on treatment patterns and clinical outcomes in unstable angina and the effectiveness of guideline reminders on implementing practice guidelines, two groups of medium and high risk patients with unstable angina were compared. BACKGROUND: New guidelines have been published by the Agency for Health Care Policy and Research (AHCPR) for evaluating and managing patients with unstable angina. The impact of these guidelines to improve the quality of care has never been tested. METHODS: Group 1 included 338 consecutive medium or high risk patients admitted before publication of the AHCPR guidelines, and group 2 consisted of 181 consecutive similar risk patients admitted after institution of the AHCPR guideline reminders at this institution. Dissemination of clinical practice guidelines was ensured by a grand rounds lecture and by posting guideline reminders on all group 2 patients' charts within 24 h of admission. RESULTS: The two groups were similar in terms of most baseline characteristics, including hypercholesterolemia, diabetes, hypertension, smoking history, baseline ST segment depression and previous coronary artery bypass graft surgery. Group 1 patients were older (68+/-13 vs. 63+/-16 years, p = 0.001) and more frequently had a previous myocardial infarction (39% vs. 22%, p = 0.001). Group 2 patients more frequently required intravenous nitroglycerin to control the index episode of chest pain (43% vs. 34%, p = 0.003). Group 2 patients more frequently received aspirin (96% vs. 88%, p = 0.009) during admission and underwent coronary angiography (71% vs. 58%, p = 0.006). More importantly, group 2 patients received oral beta-blockers (p = 0.008), aspirin and coronary angiography (p = 0.001) earlier than group 1 patients and experienced recurrent angina (29% vs. 54%) and myocardial infarction or death less frequently (3% vs. 9%, p = 0.028). CONCLUSIONS: In unstable angina, clinical practice guidelines were associated with greater use of aspirin and coronary angiography and greater use and earlier administration of beta-blockers. Variation in drug use over time was also reduced. Objective improvement in clinical outcome was also noted. Thus, practice guidelines improve the quality of care of patients with unstable angina.

Adrenergic beta-Antagonists↗
PubMed1995

Clinicolegal aspects of practice guidelines for pediatric eye and vision examination.

BACKGROUND: The American Optometric Association (AOA) recently joined a growing trend in the health care professions by adopting clinical practice guidelines. The goals of practice guidelines are to improve quality of care and to provide a more objective measure of standard of care for the legal system and the health insurance industry. Practice guidelines may eventually reduce the number and cost of malpractice actions. Historically, the standard of care for pediatric eye and vision examination has been the subject of controversy. Issues of disagreement include the amount of ocular health testing that should be performed and the determination of appropriate emphasis on functional vision. This paper summarizes the precedents that have established a legal standard of care for pediatric eye and vision examination. METHODS: A review of malpractice claims relevant to pediatric optometry was conducted. Public health policy, legal, and malpractice literature was also consulted for current views on practice guidelines. The recent AOA Optometric Clinical Practice Guidelines for Pediatric Eye and Vision Examination were compared to this review. RESULTS: Standards of care for pediatric eye examination should minimally include assessment of visual acuity, refractive error, binocular vision, functional vision, and eye health assessment including dilated funds examination with a binocular indirect ophthalmoscope. These standards are commensurate with the AOA Guidelines. CONCLUSIONS: The AOA Optometric Clinical Practice Guidelines for Pediatric Eye and Vision Examination is compared to the current standard of care for pediatric optometry. It is concluded that the Guidelines are appropriate. Optometrists should integrate these practices into patient care, and the optometric profession should seek to obtain wide spread acceptance of the Guidelines.

Adolescent↗
PubMed1996

Why we need guidelines for guidelines: a study of the quality of clinical practice guidelines in Australia.

OBJECTIVE: To appraise the quality of clinical practice guidelines (CPGs) produced in Australia. DESIGN: Cross-sectional survey. PARTICIPANTS AND SETTING: 76 organisations, comprising all clinical colleges and faculties, federal and state health departments and national and state non-government agencies involved in health policy in Australia in October 1993. OUTCOME MEASURES: Ratings for how CPGs met 18 criteria ("fully", "partially" or "not at all") for validity, reproducibility, applicability, clinical flexibility, clarity, multidisciplinary process, documentation and scheduled review. RESULTS: Response rate was 87%, with 32 organisations submitting 42 documents; 34 of these were classified as CPGs. None of the 34 CPGs fully met all criteria for quality. None fully stated costings or described processes for retrieving and synthesising evidence; only six (18%) explicitly stated the expected health outcomes; six (18%) described the method to reach consensus; and seven (21%) fully stated controversies and potential conflict with other guidelines. However, at least 75% of CPGs fully met all criteria for applicability, flexibility, multidisciplinary input and documentation and two out of three criteria for clarity. Zero to 103 references to scientific data were cited per CPG. CONCLUSION: Australian guidelines developed before the publication of the NHMRC "guidelines for guidelines" in 1995 did not meet internationally recognised criteria for quality. There is a need to apply the recommended NHMRC process and to monitor future CPG quality.

Australia↗
PubMed1992

Practice guidelines, a new reality in medicine. II. Methods of developing guidelines.

Current methods for developing practice guidelines include informal consensus development, formal consensus development, evidence-based guideline development, and explicit guideline development. Informal consensus development is the oldest and most common approach, but guidelines produced in this manner are often of poor quality and lack adequate documentation of methods. Formal consensus development uses a systematic approach to assess expert opinion and to reach agreement on recommendations. Evidence-based guideline development links recommendations directly to scientific evidence of effectiveness; rules of evidence are emphasized over expert opinion in making recommendations. Explicit guideline development clarifies the rationale by specifying the potential benefits, harms, and costs of available interventions; estimating the possibility of the outcomes; and comparing the desirability of the outcomes based on patient preferences. Steps in the development of practice guidelines include introductory decisions (selection of topic and panel members, clarification of purpose); assessments of clinical appropriateness (review of scientific evidence and expert opinion); assessment of public policy issues (resource limitations, feasibility issues); and guideline document development and evaluation (drafting of document, peer review, and pretesting).

Clinical Protocols↗