Content area
Full text
PERSPECTIVE
Professional societies have been heavily involved in the development of practice guidelines-but not their application in practice.
ABSTRACT Major opportunity exists to better align clinical science and clinical practice. To do so will require efforts not only to develop clinical practice guidelines, but to facilitate their application in practice. The American College of Cardiology operates a program to develop and assess the effectiveness of tools that facilitate the application of guidelines in practice. Here we review what we have learned about the process of guideline implementation, lay out the major research questions that need to be addressed, and argue that professional societies play a critical role in moving from guideline development to application.
THE INSTITUTE OF MEDICINE (IOM) defines quality as those -health services for individuals and populations [that] increase the likelihood of desired health outcomes and are consistent with current professional knowledge."1 The operational challenge we face as we consider strategies to bridge the quality chasm is to anchor care in "current professional knowledge." Efforts to bring this knowledge into practice offer the best hope for real and sustained improvement.
Many organizations are working to make science more available to practitioners. Typically, this proceeds through the development of clinical practice guidelines.2 One might suppose that dissemination of such guidelines would naturally lead to the grounding of clinical practice in clinical science. Unfortunately, there is good evidence that this is not the case.3
A few organizations have undertaken to address this-that is, have moved from producing guidelines to studying their application. There are isolated publications from the experience of academic medical centers.4 The Institute for Healthcare Improvement (IHI) has, through its Breakthrough Series, organized efforts to improve quality.5 Many of its projects have implicitly or explicitly focused on increasing rates of guideline use. The Agency for Healthcare Research and Quality (AHRQ), through its Translating Research Into Practice (TRIP) projects, has stimulated innovation in this field, although little has yet been published.6 The Centers for Medicare and Medicaid Services (CMS) has documented improved indicators of guideline compliance for cardiovascular care in its Cooperative Cardiovascular Project (CCP).7 Almost certainly, managed care organizations have led efforts that explain improvements in rates of Health Plan Employer Data and Information Set (HEDIS) measures (many of which...