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Posted on 03.04.02
UNC CERTs: Making Practice Guidelines Easier to Use
By Starr L. Nicely, BS, Sue Tolleson-Rinehart, PhD, and Lucy A. Savitz, PhD, MBA
More and more people are turning to evidence-based medicine to help improve care. Evidence-based medicine includes several tools. One of the tools is a "clinical practice guideline." Clinical practice guidelines try to turn the best scientific knowledge into plans for giving the best care to patients.
Doctors often find it hard to use guidelines in their day-to-day practices. UNC CERTs investigator Dr. Lucy Savitz is changing that, by making it easier to use guidelines for many common childhood illnesses. Dr. Savitz's project is called "Troubles in Paradox? A Tailored Implementation Strategy for Therapeutic Guidelines," and it is a part of the UNC CERTs.
Dr. Savitz and the experts working with her created a more reasonable plan to help doctors and other healthcare professionals adopt guidelines. They began by finding out why guidelines can be hard to use. For example, many guidelines are too general - they may not help the kinds of patients a doctor usually sees. They are also made mainly for doctors to use.
Guidelines are more useful when they can be tailored to different kinds of patients and different kinds of care. They also need to be useful to other members of the team of healthcare providers, including the parents of sick children.
Doctors also need to think about the result they are looking for in each case. Sometimes, that may be to keep illness from happening. At other times, it may be to manage an illness that has already occurred. It is also true that we don't always know how using guidelines might affect the cost of healthcare. Using some guidelines can make care more costly, when they recommend care that otherwise would not be given. Other guidelines can save money by keeping sickness from happening in the first place. Guidelines should always put patients and their needs at the center of care.
Dr. Savitz's new plan can make it easier to use many clinical practice guidelines. For example, her project shows us how to use guidelines for treating children with diabetes and asthma, those dependent on a ventilator, and those with cystic fibrosis or spinal-cord injuries. We can expect big improvements in healthcare for children when guidelines are easier to use.
For some examples of clinical practice guidelines provided by the American Academy of Pediatrics, click here.