Clinical Practice Guideline Selection, Development, Implementation, and Evaluation
Abstract
This paper discusses issues relating to clinical practice guideline development and implementation, and recommends a step by step plan for guideline use in the Department of Defense. Individual clinical expertise and opinion has historically taken precedence over an evidence based approach, which has resulted in large amounts of practice variation throughout the Military Healthcare System. Clinical practice guidelines attempt to reduce this practice variation and improve patient outcomes by using evidence based medicine and identifying best practices. The DoD/VA Low Back Pain Clinical Practice Guideline was utilized as an example of how to select, finalize, implement, evaluate, and adjust clinical practice guidelines effectively. A retrospective review of patient medical records and tracking sheets was conducted to determine if the clinical practice guidelines were being followed, and if the proper referrals were being made. The study found that guideline implementation can be a lengthy process, but once fully implemented, can result in improved outcomes and reduced costs and practice variations. Recommendations are made as to how to most efficiently choose clinical practice guidelines for individual healthcare organizations, how to best prepare for implementation, how to implement, and how to evaluate and continuously improve the guidelines once implemented. The Military Healthcare System can dramatically cut costs, improve access for beneficiaries, and most importantly improve patient outcomes by working together to develop, select, and use numerous clinical practice guidelines. To do so optimally, it is imperative that barriers to implementation, appropriate training, command influence and physician buy in, local guideline requirements, proper metrics, and the most recent medical technology and best practice be considered when selecting, developing, implementing, and evaluating clinical practice guidelines.
Document Details
- Document Type
- Technical Report
- Publication Date
- Feb 01, 2000
- Accession Number
- AD1199211
Entities
People
- Christopher M. Christon