Does every woman who
has a miscarriage require a dilation and curettage (D&C)? Does every
patient with new-onset headache require a computed tomographic (CT)
scan? Does every child with otitis media need a 10-day course of
antibiotics? Does every woman with pelvic inflammatory disease (PID)
These are popular and appropriate questions to ask and investigate in
1999 but challenged conventional medical wisdom in the early to mid
1980s, when a group of practicing family physicians in the Ambulatory
Sentinel Practice Network (ASPN; http://www.aspn.denver.co.us) began a series of descriptive studies of current practices for common
clinical dilemmas they faced in everyday practice. Their early work
suggested that the then-current National Institutes of Health Consensus
Guidelines for use of CT scanning in new-onset headache were not being
followed and that the gap between practice and the guidelines led to no
measureable harm to patients1- 3 and to a considerable
reduction in health care costs.4 Subsequent studies further
questioned the appropriateness of routine D&C after uncomplicated
miscarriage,5 hospitalization of every woman with
PID,6 and the routine use of a 10-day course of antibiotics
for children with uncomplicated otitis media.7 In
conducting these early studies, ASPN pioneered methods for low-cost,
low-burden studies that collect high-quality data in busy primary care
practice settings4 and laid the groundwork for studying the
common phenomena of primary care. Future work will advance
understanding of appropriate care for these and other clinical
questions faced by primary care physicians in their daily work.
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