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June 25, 1997, Vol 277, No. 24 >
ARTICLE | June 25, 1997

Practice Guidelines and Prediction Rules Should Be Subject to Careful Clinical Testing FREE

Scott Weingarten, MD, MPH
[+] Author Affiliations

Cedars-Sinai Medical Center operates a subsidiary, Zynx Health, which markets clinical decision support software and consulting services.

Reprints: Scott Weingarten, MD, MPH, Cedars-Sinai Health System, 200 N Robertson St, Suite 205, Beverly Hills, CA 90211 (e-mail: Weingarten@csmc.edu).


JAMA. 1997;277(24):1977-1978. doi:10.1001/jama.1997.03540480077043
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References

Practice guidelines, prediction rules, and protocols are now everywhere. During the past decade, a number of guidelines and prediction rules have become available to assist clinicians and patients in the diagnosis and treatment of many different conditions. Whether clinical recommendations are expressed as clinical practice guidelines, prediction rules, or protocols the intent is clear: to inform medical decisions and to decrease variations in care by systematically influencing clinical decisions. Specifically, the goal is to change the way we care for patients. In the past, there have been few intrusions in the privacy of the physician-patient relationship, and some clinicians are bcoming concerned that prediction rules and guidelines will devalue the "art of medicine" and threaten clinical autonomy.

See also p 1935.

Other clinicians may dismiss guidelines and prediction rules as another fad in health care management that will be replaced by the next up-and-coming fad. In support of their argument

REFERENCES

1 +
Reiman AS.  Assessment and accountability: the third revolution in medical care . N Engl J Med . 1988;;319:1220-1222.
2 +
Grimshaw JM, Russell IT.  Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations . Lancet . 1993;;342:1317-1322.
3 +
Johnston ME, Langton KB, Haynes RB, Mathieu A.  Effects of computer-based clinical decision support systems on clinician performance and patient outcome: a critical appraisal of research . Ann Intern Med . 1994;;120:135-142.
4 +
Auleley G-R, Ravaud P, Giraudeau B, et al.  Implementation of the Ottawa ankle rules in France: a multicenter randomized controlled trial . JAMA . 1997;;277:1935-1939.
5 +
McDonald CJ, Overhage JM.  Guidelines you can follow and can trust: an ideal and an example . JAMA . 1994;;271:872-873.
6 +
Selker HP.  Criteria for adoption in practice of medical practice guidelines . Am J Cardiol . 1993;;71:339-341.
7 +
Greco PJ, Eisenberg JM.  Changing physicians' practices . N Engl J Med . 1993;;329:1271-1273.
8 +
Katz DA, Griffith JL, Beshansky JR, Selker HP.  The use of empiric clinical data in the evaluation of practice guidelines for unstable angina . JAMA . 1996;;276:1568-1574.
9 +
Ellrodt AG, Conner L, Riedinger M, Weingarten S.  Measuring and improving physician compliance with clinical practice guidelines: a controlled interventional trial . Ann Intern Med . 1995;;122:277-282.
10 +
Weingarten S, Riedinger M, Conner L, Johnson B, Ellrodt AG.  Reducing lengths of stay in the coronary care unit with a practice guideline for patients with congestive heart failure: insights from a controlled clinical trial . Med Care . 1994;;12:1232-1243.
11 +
Phelps CE.  The methodologic foundations of studies of the appropriateness of medical care . N Engl J Med . 1993;;329:1241-1245.
12 +
Kong GK, Belman MJ, Weingarten S.  Reducing length of stay for patients hospitalized with exacerbation of COPD using a practice guideline . Chest . 1997;;111:89-94.
13 +
Soumerai SB, Ross-Degnan D, Avorn J, McLaughlin TJ, Choodnovskiy I.  Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes . N Engl J Med . 1991;;325:1072-1077.
14 +
Brown JB, Shye D, McFarland B.  The paradox of guideline implementation: how AHCPR's depression guideline was adapted at Kaiser Permanente Northwest Region . Jt Comm J Qual Improv . 1995;;21:5-21.
15 +
Harman JG, Limbird LE, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics . 9th ed. New York, NY: McGraw-Hill Book Co; 1996;.
16 +
Berwick DM.  Continuous improvement as an ideal in health care . N Engl J Med . 1989;;320:53-56.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Reiman AS.  Assessment and accountability: the third revolution in medical care . N Engl J Med . 1988;;319:1220-1222.
2 +
Grimshaw JM, Russell IT.  Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations . Lancet . 1993;;342:1317-1322.
3 +
Johnston ME, Langton KB, Haynes RB, Mathieu A.  Effects of computer-based clinical decision support systems on clinician performance and patient outcome: a critical appraisal of research . Ann Intern Med . 1994;;120:135-142.
4 +
Auleley G-R, Ravaud P, Giraudeau B, et al.  Implementation of the Ottawa ankle rules in France: a multicenter randomized controlled trial . JAMA . 1997;;277:1935-1939.
5 +
McDonald CJ, Overhage JM.  Guidelines you can follow and can trust: an ideal and an example . JAMA . 1994;;271:872-873.
6 +
Selker HP.  Criteria for adoption in practice of medical practice guidelines . Am J Cardiol . 1993;;71:339-341.
7 +
Greco PJ, Eisenberg JM.  Changing physicians' practices . N Engl J Med . 1993;;329:1271-1273.
8 +
Katz DA, Griffith JL, Beshansky JR, Selker HP.  The use of empiric clinical data in the evaluation of practice guidelines for unstable angina . JAMA . 1996;;276:1568-1574.
9 +
Ellrodt AG, Conner L, Riedinger M, Weingarten S.  Measuring and improving physician compliance with clinical practice guidelines: a controlled interventional trial . Ann Intern Med . 1995;;122:277-282.
10 +
Weingarten S, Riedinger M, Conner L, Johnson B, Ellrodt AG.  Reducing lengths of stay in the coronary care unit with a practice guideline for patients with congestive heart failure: insights from a controlled clinical trial . Med Care . 1994;;12:1232-1243.
11 +
Phelps CE.  The methodologic foundations of studies of the appropriateness of medical care . N Engl J Med . 1993;;329:1241-1245.
12 +
Kong GK, Belman MJ, Weingarten S.  Reducing length of stay for patients hospitalized with exacerbation of COPD using a practice guideline . Chest . 1997;;111:89-94.
13 +
Soumerai SB, Ross-Degnan D, Avorn J, McLaughlin TJ, Choodnovskiy I.  Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes . N Engl J Med . 1991;;325:1072-1077.
14 +
Brown JB, Shye D, McFarland B.  The paradox of guideline implementation: how AHCPR's depression guideline was adapted at Kaiser Permanente Northwest Region . Jt Comm J Qual Improv . 1995;;21:5-21.
15 +
Harman JG, Limbird LE, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics . 9th ed. New York, NY: McGraw-Hill Book Co; 1996;.
16 +
Berwick DM.  Continuous improvement as an ideal in health care . N Engl J Med . 1989;;320:53-56.

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