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Clinical Practice Guidelines
Implementation
of evidence-based clinical practice guidelines
is one strategy VHA has embraced to improve
care by reducing variation in practice and
systematizing “best practices”.
Guidelines, as generic tools to improve
the processes of care for patient cohorts,
serve to reduce errors, and provide consistent
quality of care and utilization of resources
throughout the system. Guidelines also are
cornerstones for accountability and facilitate
learning and the conduct of research. The
guidelines on this site are those endorsed
by VHA's National Clinical Practice Guidelines
Council.
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Clinical
practice guidelines initially evolved in
response to studies demonstrating significant
variations in risk-adjusted practice patterns
and costs. Researchers hypothesized that
establishing criteria for the appropriate
use of procedures and services might decrease
inappropriate utilization and improve patient
outcomes.
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VHA
Guidelines
VHA,
in collaborations with the
Department of Defense (DoD) and other leading
professional organizations, has been developing
clinical practice guidelines since the early 1990s.
Guidelines for the Rehabilitation of Stroke and
Amputation and the Care Guide for Ischemic Heart
Disease were among the first distributed throughout
VHA in 1996 and 1997. Since that time, numerous
others, including guidelines on Diabetes Mellitus,
COPD, Major Depressive Disorder, Psychoses, Tobacco
Use Cessation, Hypertension, and more, have been
developed and distributed for implementation throughout
the system.
VHA
defines Clinical Practice Guidelines as recommendations
for the performance or exclusion of specific procedures
or services for specific disease entities. These
recommendations are derived through a rigorous
methodological approach that includes a systematic
review of the evidence to outline recommended
practice. Guidelines are frequently displayed
in the form of an algorithm, which is a set of
rules, in a flowchart format, for solving a problem
in a finite number of steps. Clinical guidelines
are seen by many as a potential solution to inefficiency
and inappropriate variation in care. However,
it is acknowledged that the use of guidelines
must always be applied in the context of a provider's
clinical judgment for the care of a particular
patient. For that reason, the guidelines may be
viewed as an educational tool analogous to textbooks
and journals, but in a more user-friendly format.
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