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November 26, 1997, Vol 278, No. 20 >
ARTICLE | November 26, 1997

Evidence-Based Disease Management FREE

Gray Ellrodt, MD; Deborah J. Cook, MD; Jean Lee, MD; Michaela Cho, PharmD; Dereck Hunt, MD; Scott Weingarten, MD, MPH
[+] Author Affiliations

Reprints: Deborah J. Cook, MD, Department of Medicine, Division of General Internal Medicine, St Joseph's Hospital, 50 Charlton Ave E, Hamilton, Ontario, Canada L8N 4A6.


JAMA. 1997;278(20):1687-1692. doi:10.1001/jama.1997.03550200063033
Text Size: A A A
Published online
Article
References

Disease management is an approach to patient care that emphasizes coordinated, comprehensive care along the continuum of disease and across health care delivery systems. Evidence-based medicine is an approach to practice and teaching that integrates pathophysiological rationale, caregiver experience, and patient preferences with valid and current clinical research evidence. Using diabetes mellitus as an example, we describe the importance of evidence-based medicine to the development of disease management programs. We present a method for developing and implementing evidence-based clinical guidelines, clinical pathways, and algorithms and describe the creation of systems to measure and report processes and outcomes that could drive quality improvement in diabetes care. Multidisciplinary teams are ideally suited to develop, lead, and implement evidence-based disease management programs, since they play an essential role in the preventive, diagnostic, and therapeutic decisions for patients with diabetes throughout the course of their disease.

REFERENCES

1 +
The Boston Consulting Group. The Promise of Disease Management . Boston, Mass: The Boston Consulting Group Inc; 1995;.
2 +
Meyer LC, Rohl B.  An innovative approach to treating chronic disabling asthma . Case Manager . 1993;;4:54-69.
3 +
Lumsdon K.  Disease management: the heat and headaches over retooling patient care create hard labor . Hosp Health Netw . 1995;;69( (7) ):34-42.
4 +
Harris JM.  Disease management: new wine in new bottles? Ann Intern Med . 1996;;124:838-842.
5 +
Epstein RS, Sherwood LM.  From outcomes research to disease management: a guide for the perplexed . Ann Intern Med . 1996;;124:832-837.
6 +
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS.  Evidence based medicine: what it is and what it isn't . BMJ . 1996;;312:71-72.
7 +
Evidence-Based Medicine Working Group.  Evidence-based medicine: a new approach to teaching the practice of medicine . JAMA . 1992;;268:2420-2425.
8 +
Noble J, Bithoney W, MacDonald P, et al.  The core content of generalist curriculum for general internal medicine, family practice and pediatrics . J Gen Intern Med . 1994;;9( (suppl) ):31S-42S.
9 +
Cook DJ, Griffith L, Sackett DL.  Importance of and satisfaction with work and professional interpersonal issues: a survey of physicians practising general internal medicine in Ontario . Can Med Assoc J . 1995;;153:755-764.
10 +
Oxman AD, Thomson MA, Davis DA, Haynes RB.  No magic bullets: a systematic review of 102 trials of interventions to improve professional practice . Can Med Assoc J . 1995;;153:1423-1431.
11 +
Grimshaw JM, Russell IT.  Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations . Lancet . 1993;;342:1317-1322.
12 +
Grimshaw J, Freemantle N, Wallace S, et al.  Developing and implementing clinical practice guidelines . Qual Health Care . 1995;;4:55-64.
13 +
Davis DA, Thomson MA, Oxman AD, Haynes RB.  Evidence for the effectiveness of CME: a review of 50 randomized controlled trials . JAMA . 1992;;268:1111-1117.
14 +
Evidence Based Resource Group.  Evidence based care, 1: setting priorities: how important is this problem? Can Med Assoc J . 1994;;150:1249-1254.
15 +
Evidence Based Resource Group.  Evidence based care, 2: setting guidelines: how should we manage this problem? Can Med Assoc J . 1994;;150:1417-1423.
16 +
Evidence Based Resource Group.  Evidence based care, 3: measuring performance: how are we managing this problem? Can Med Assoc J . 1994;;150:1575-1579.
17 +
Evidence Based Resource Group.  Evidence based care, 4: improving performance: how can we improve the way we manage this problem? Can Med Assoc J . 1994;;150:1793-1796.
18 +
Evidence Based Resource Group.  Evidence based medicine, 5: lifelong learning: how can we learn to be more effective? Can Med Assoc J . 1994;;150:1971-1973.
19 +
Ellrodt AG, Cho M.  Introduction to evidencebased practice . In: Aydin CE, Burnes Bolton L, Weingarten SR, eds. Patient-Focused Care in the Hospital: Restructuring and Redesign Methods to Achieve Better Outcomes . New York, NY: Faulkner & Gray Inc; 1995;.
20 +
Deignan M, Ellrodt AG.  Resource management . In: Aydin CE, Burnes Bolton L, Weingarten SR, eds. Patient-Focused Care in the Hospital: Restructuring and Redesign Methods to Achieve Better Outcomes . New York, NY: Faulkner & Gray Inc; 1995;.
21 +
Ellrodt AG, Conner L, Riedinger M, Weingarten SR.  Measuring and improving physician compliance with clinical practice guidelines: a controlled interventional trial . Ann Intern Med . 1995;;122:277-282.
22 +
Hiss RG, Greenfield S.  Forum three: changes in the US health care system that would facilitate improved care for non-insulin-dependent diabetes mellitus . Ann Intern Med . 1996;;124( (part 2) ):180-186.
23 +
Barondess JA.  The future of generalism . Ann Intern Med . 1993;;119:153-160.
24 +
Quickel KE.  Diabetes in a managed care system . Ann Intern Med . 1995;;124( (pt 2) ):160-163.
25 +
Nathan DM.  Long-term complications of diabetes mellitus . N Engl J Med . 1993;;328:1676-1685.
26 +
Clark CM Jr, Lee DA.  Prevention and treatment of the complications of diabetes mellitus . N Engl J Med . 1995;;332:1210-1217.
27 +
Federated Council for Internal Medicine.  General internal medicine and general internists: recognizing a national need . Ann Intern Med . 1992;;117:778-779.
28 +
Mulrow CD.  Reconnoitering critical pathways and guidelines . J Gen Intern Med . 1996;;11:185-186.
29 +
Lee TH.  Beyond guidelines: can general internists show the clinical paths? J Gen Intern Med . 1996;;11:174-176.
30 +
Wilczynski NL, Walker CJ, McKibbon KA, Haynes RB.  Assessment of methodologic quality search filters in MEDLINE . Proc Annu Symp Comp Appl Med Care . 1994;;17:601-605.
31 +
Haynes RB, Wilczynski N, McKibbon A, Walker C, Sinclair J.  Developing optimal search strategies for detecting clinically sound studies in MEDLINE . J Am Med Informatics Assoc . 1994;;1:447-458.
32 +
Cook DJ, Sackett DL, Spitzer WO.  Methodological guidelines for systematic review of randomized control trials in health care from the Potsdam Consultation on Meta-analysis . J Clin Epidemiol . 1995;;48:167-171.
33 +
Kasiske BL, Kalil RS, Ma JZ, Liao M, Keane WF.  Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis . Ann Intern Med . 1993;;118:129-138.
34 +
Peters AL, Davidson MB.  Insulin plus a sulfonylurea agent for treating type 2 diabetes . Ann Intern Med . 1991;;115:45-53.
35 +
Javitt JC, Aiello LP.  Cost-effectiveness of detecting and treating diabetic retinopathy . Ann Intern Med . 1996;;124( (pt 2) ):164-169.
36 +
Eckman ME, Greenfield S, Mackey WC.  Foot infections in diabetic patients: decision and costeffectiveness analyses . JAMA . 1995;;273:712-720.
37 +
Siegel JE, Krolewski AS, Warram JH, Weinstein MC.  Cost-effectiveness of screening and early treatment of nephropathy in patients with insulindependent diabetes mellitus . J Am Soc Nephrol . 1992;;3:S111-S119.
38 +
Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine; Field MJ, Lohr KN, eds. Clinical Practice Guidelines: Directions for a New Program . Washington, DC: National Academy Press; 1990;.
39 +
Sackett DL, Haynes RB.  On the need for evidence-based medicine . Evidence-Based Med . 1995;;1( (1) ):5-6.
40 +
American Diabetes Association.  Clinical practice recommendations 1995 . Diabetes Care . 1995;;18 ( (suppl 1) ):1-96.
41 +
Expert Committee of the Canadian Diabetes Advisory Board.  Clinical practice guidelines for treatment of diabetes mellitus . Can Med Assoc J . 1992;;147:697-712.
42 +
Tinker LF, Heins JM, Holler HJ.  Commentary and translation: 1994 nutrition recommendation for diabetes . J Am Dietetic Assoc . 1994;;94:507-511.
43 +
Alberti KG, Gries FA, Jervell J, Krans HM.  A desktop guide for the management of non-insulin-dependent diabetes mellitus (NIDDM): an update: European NIDDM Policy Group . Diabetic Med . 1994;;11:899-909.
44 +
American College of Physicians, American Diabetes Association, and American Academy of Ophthalmology.  Screening guidelines for diabetic retinopathy . Ann Intern Med . 1992;;116:683-685.
45 +
Guyatt GH, Rennie D.  Users' guides to the medical literature . JAMA . 1993;;270:2096-2097.
46 +
Oxman AD, Cook DJ, Guyatt GH, for the Evidence-Based Medicine Working Group.  Users' guides to the medical literature, VI: how to use an overview . JAMA . 1994;;272:1367-1371.
47 +
Drummond MF, Richardson WS, O'Brien BJ, Levine M, Heyland DK, for the Evidence-Based Medicine Working Group.  Users' guides to the medical literature, XII: how to use an article on economic analysis of clinical practice, A: are the results of the study valid? JAMA . 1997;;277:1552-1557.
48 +
O'Brien BJ, Heyland DK, Richardson WS, Levine M, Drummond MF, for the Evidence-Based Medicine Working Group.  Users' guides to the medical literature, XII: how to use an article on economic analysis of clinical practice, B: what are the results and will they help me in caring for my patients? JAMA . 1997;;277:1802-1806.
49 +
Hayward RSA, Wilson MC, Tunis SR, Bass ER, Guyatt GH, for the Evidence-Based Medicine Working Group.  Users' guides to the medical literature, VIII: how to use clinical practice guidelines, A: are the recommendations valid? JAMA . 1995;;274:570-574.
50 +
Hayward RSA, Wilson MC, Tunis SR, Bass ER, Guyatt GH, for the Evidence-Based Medicine Working Group.  Users' guides to the medical literature, IX: how to use clinical practice guidelines, B: what are the results and will they help me in caring for my patients? JAMA . 1995;;274:1630-1632.
51 +
Cook DJ, Guyatt GH, Laupacis A, Sackett DL, Goldberg RJ.  Clinical recommendations using levels of evidence for antithrombotic agents . Chest . 1995;;108:227S-230S.
52 +
Browman G, Levine MN, Mohide A, et al.  The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation . J Clin Oncol . 1995;;13:502-512.
53 +
Eddy DM.  The challenge . JAMA . 1990;;263:287-290.
54 +
Pearson SD, Goulart-Fisher D, Lee TH.  Critical pathways as a strategy for improving care: problems and potential . Ann Intern Med . 1995;;123:941-948.
55 +
Schoenbaum SC, ed. Using Clinical Practice Guidelines to Evaluate Quality of Care . Washington, DC: US Dept of Health and Human Services; 1995;. Agency for Health Care Policy and Research publication 95-0045.
56 +
Fang E, Mittman BS, Weingarten SR.  Use of clinical practice guidelines in managed care physician groups . Arch Fam Med . 1996;;5:528-531.
57 +
The Diabetes Control and Complications Trial Research Group.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus . N Engl J Med . 1993;;329:977-986.
58 +
Hayward RSA, Wilson MC, Tunis SR, Guyatt GH, Moore KA, Bass EB.  Practice guidelines: what are internists looking for? J Gen Intern Med . 1996;;11:176-178.
59 +
Yandell B.  Critical paths at Alliant Health System . Qual Manage Health Care . 1995;;3:55-64.
60 +
Lomas J, Enkin M, Anderson GM, Hannah WJ, Vayda E, Singer J.  Opinion leaders vs audit and feedback to implement practice guidelines: delivery after previous cesarean section . JAMA . 1991;;265:2202-2207.
61 +
Soumerai SB, Avorn J.  Principles of educational outreach ('academic detailing') to improve clinical decision making . JAMA . 1990;;263:549-556.
62 +
Weingarten SR, Riedinger MS, Conner L, et al.  Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain . Ann Intern Med . 1994;;120:257-263.
63 +
Larsen RA, Evans RS, Burke JP, Pestotnik SL, Gardner RM, Classen DC.  Improved perioperative antibiotic use and reduced surgical wound infections through use of computer decision analysis . Infect Control Hosp Epidemiol . 1989;;10:316-320.
64 +
Tierney WM, Miller ME, Overhage JM, McDonald CJ.  Physician inpatient order writing on microcomputer work stations: effects on resource utilization . JAMA . 1993;;269:379-383.
65 +
Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM.  A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure . N Engl J Med . 1995;;333:1190-1195.
66 +
Greco PJ, Eisenberg JM.  Changing physicians' practices . N Engl J Med . 1993;;329:1271-1274.
67 +
Tunis SR, Hayward RSA, Wilson MC, et al.  Internists' attitudes about clinical practice guidelines . Ann Intern Med . 1994;;120:956-963.
68 +
Weingarten SR, Riedinger MS, Hobson P, et al. Evaluation of a pneumonia practice guideline in an interventional trial. Am Rev Resp Crit Care Med. In press.
69 +
Aucott JN, Pelecanos E, Dombrowski R, Fuehrer SM, Laich J, Aron DC.  Implementation of local guidelines for cost-effective management of hypertension . J Gen Intern Med . 1996;;11:139-146.
70 +
Fitzgerald JF, Smith DM, Martin DK, Freedman JA, Katz BP.  A case manager intervention to reduce readmissions . Arch Intern Med . 1994;;154:1721-1729.
71 +
Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M.  Comprehensive discharge planning for the hospitalized elderly: a randomized clinical trial . Ann Intern Med . 1994;;120:999-1006.
72 +
Katon W, Von Korff M, Lin E, et al.  Collaborative management to achieve treatment guidelines: impact on depression in primary care . JAMA . 1995;;273:1026-1031.
73 +
Weinberger M, Oddone E, Henderson WG, for the Veterans Affairs Co-operative Study Group on Primary Care and Hospital Readmission.  Does increased access to primary care reduce hospital readmissions? N Engl J Med . 1996;;334:1441-1447.
74 +
Lavizzo-Mourey R, Mackenzie ER.  Cultural competence: essential measurements of quality for managed care organizations . Ann Intern Med . 1996;;124:919-920.

Figures

Tables

Interactive Graphics

Video

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 +
The Boston Consulting Group. The Promise of Disease Management . Boston, Mass: The Boston Consulting Group Inc; 1995;.
2 +
Meyer LC, Rohl B.  An innovative approach to treating chronic disabling asthma . Case Manager . 1993;;4:54-69.
3 +
Lumsdon K.  Disease management: the heat and headaches over retooling patient care create hard labor . Hosp Health Netw . 1995;;69( (7) ):34-42.
4 +
Harris JM.  Disease management: new wine in new bottles? Ann Intern Med . 1996;;124:838-842.
5 +
Epstein RS, Sherwood LM.  From outcomes research to disease management: a guide for the perplexed . Ann Intern Med . 1996;;124:832-837.
6 +
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS.  Evidence based medicine: what it is and what it isn't . BMJ . 1996;;312:71-72.
7 +
Evidence-Based Medicine Working Group.  Evidence-based medicine: a new approach to teaching the practice of medicine . JAMA . 1992;;268:2420-2425.
8 +
Noble J, Bithoney W, MacDonald P, et al.  The core content of generalist curriculum for general internal medicine, family practice and pediatrics . J Gen Intern Med . 1994;;9( (suppl) ):31S-42S.
9 +
Cook DJ, Griffith L, Sackett DL.  Importance of and satisfaction with work and professional interpersonal issues: a survey of physicians practising general internal medicine in Ontario . Can Med Assoc J . 1995;;153:755-764.
10 +
Oxman AD, Thomson MA, Davis DA, Haynes RB.  No magic bullets: a systematic review of 102 trials of interventions to improve professional practice . Can Med Assoc J . 1995;;153:1423-1431.
11 +
Grimshaw JM, Russell IT.  Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations . Lancet . 1993;;342:1317-1322.
12 +
Grimshaw J, Freemantle N, Wallace S, et al.  Developing and implementing clinical practice guidelines . Qual Health Care . 1995;;4:55-64.
13 +
Davis DA, Thomson MA, Oxman AD, Haynes RB.  Evidence for the effectiveness of CME: a review of 50 randomized controlled trials . JAMA . 1992;;268:1111-1117.
14 +
Evidence Based Resource Group.  Evidence based care, 1: setting priorities: how important is this problem? Can Med Assoc J . 1994;;150:1249-1254.
15 +
Evidence Based Resource Group.  Evidence based care, 2: setting guidelines: how should we manage this problem? Can Med Assoc J . 1994;;150:1417-1423.
16 +
Evidence Based Resource Group.  Evidence based care, 3: measuring performance: how are we managing this problem? Can Med Assoc J . 1994;;150:1575-1579.
17 +
Evidence Based Resource Group.  Evidence based care, 4: improving performance: how can we improve the way we manage this problem? Can Med Assoc J . 1994;;150:1793-1796.
18 +
Evidence Based Resource Group.  Evidence based medicine, 5: lifelong learning: how can we learn to be more effective? Can Med Assoc J . 1994;;150:1971-1973.
19 +
Ellrodt AG, Cho M.  Introduction to evidencebased practice . In: Aydin CE, Burnes Bolton L, Weingarten SR, eds. Patient-Focused Care in the Hospital: Restructuring and Redesign Methods to Achieve Better Outcomes . New York, NY: Faulkner & Gray Inc; 1995;.
20 +
Deignan M, Ellrodt AG.  Resource management . In: Aydin CE, Burnes Bolton L, Weingarten SR, eds. Patient-Focused Care in the Hospital: Restructuring and Redesign Methods to Achieve Better Outcomes . New York, NY: Faulkner & Gray Inc; 1995;.
21 +
Ellrodt AG, Conner L, Riedinger M, Weingarten SR.  Measuring and improving physician compliance with clinical practice guidelines: a controlled interventional trial . Ann Intern Med . 1995;;122:277-282.
22 +
Hiss RG, Greenfield S.  Forum three: changes in the US health care system that would facilitate improved care for non-insulin-dependent diabetes mellitus . Ann Intern Med . 1996;;124( (part 2) ):180-186.
23 +
Barondess JA.  The future of generalism . Ann Intern Med . 1993;;119:153-160.
24 +
Quickel KE.  Diabetes in a managed care system . Ann Intern Med . 1995;;124( (pt 2) ):160-163.
25 +
Nathan DM.  Long-term complications of diabetes mellitus . N Engl J Med . 1993;;328:1676-1685.
26 +
Clark CM Jr, Lee DA.  Prevention and treatment of the complications of diabetes mellitus . N Engl J Med . 1995;;332:1210-1217.
27 +
Federated Council for Internal Medicine.  General internal medicine and general internists: recognizing a national need . Ann Intern Med . 1992;;117:778-779.
28 +
Mulrow CD.  Reconnoitering critical pathways and guidelines . J Gen Intern Med . 1996;;11:185-186.
29 +
Lee TH.  Beyond guidelines: can general internists show the clinical paths? J Gen Intern Med . 1996;;11:174-176.
30 +
Wilczynski NL, Walker CJ, McKibbon KA, Haynes RB.  Assessment of methodologic quality search filters in MEDLINE . Proc Annu Symp Comp Appl Med Care . 1994;;17:601-605.
31 +
Haynes RB, Wilczynski N, McKibbon A, Walker C, Sinclair J.  Developing optimal search strategies for detecting clinically sound studies in MEDLINE . J Am Med Informatics Assoc . 1994;;1:447-458.
32 +
Cook DJ, Sackett DL, Spitzer WO.  Methodological guidelines for systematic review of randomized control trials in health care from the Potsdam Consultation on Meta-analysis . J Clin Epidemiol . 1995;;48:167-171.
33 +
Kasiske BL, Kalil RS, Ma JZ, Liao M, Keane WF.  Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis . Ann Intern Med . 1993;;118:129-138.
34 +
Peters AL, Davidson MB.  Insulin plus a sulfonylurea agent for treating type 2 diabetes . Ann Intern Med . 1991;;115:45-53.
35 +
Javitt JC, Aiello LP.  Cost-effectiveness of detecting and treating diabetic retinopathy . Ann Intern Med . 1996;;124( (pt 2) ):164-169.
36 +
Eckman ME, Greenfield S, Mackey WC.  Foot infections in diabetic patients: decision and costeffectiveness analyses . JAMA . 1995;;273:712-720.
37 +
Siegel JE, Krolewski AS, Warram JH, Weinstein MC.  Cost-effectiveness of screening and early treatment of nephropathy in patients with insulindependent diabetes mellitus . J Am Soc Nephrol . 1992;;3:S111-S119.
38 +
Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine; Field MJ, Lohr KN, eds. Clinical Practice Guidelines: Directions for a New Program . Washington, DC: National Academy Press; 1990;.
39 +
Sackett DL, Haynes RB.  On the need for evidence-based medicine . Evidence-Based Med . 1995;;1( (1) ):5-6.
40 +
American Diabetes Association.  Clinical practice recommendations 1995 . Diabetes Care . 1995;;18 ( (suppl 1) ):1-96.
41 +
Expert Committee of the Canadian Diabetes Advisory Board.  Clinical practice guidelines for treatment of diabetes mellitus . Can Med Assoc J . 1992;;147:697-712.
42 +
Tinker LF, Heins JM, Holler HJ.  Commentary and translation: 1994 nutrition recommendation for diabetes . J Am Dietetic Assoc . 1994;;94:507-511.
43 +
Alberti KG, Gries FA, Jervell J, Krans HM.  A desktop guide for the management of non-insulin-dependent diabetes mellitus (NIDDM): an update: European NIDDM Policy Group . Diabetic Med . 1994;;11:899-909.
44 +
American College of Physicians, American Diabetes Association, and American Academy of Ophthalmology.  Screening guidelines for diabetic retinopathy . Ann Intern Med . 1992;;116:683-685.
45 +
Guyatt GH, Rennie D.  Users' guides to the medical literature . JAMA . 1993;;270:2096-2097.
46 +
Oxman AD, Cook DJ, Guyatt GH, for the Evidence-Based Medicine Working Group.  Users' guides to the medical literature, VI: how to use an overview . JAMA . 1994;;272:1367-1371.
47 +
Drummond MF, Richardson WS, O'Brien BJ, Levine M, Heyland DK, for the Evidence-Based Medicine Working Group.  Users' guides to the medical literature, XII: how to use an article on economic analysis of clinical practice, A: are the results of the study valid? JAMA . 1997;;277:1552-1557.
48 +
O'Brien BJ, Heyland DK, Richardson WS, Levine M, Drummond MF, for the Evidence-Based Medicine Working Group.  Users' guides to the medical literature, XII: how to use an article on economic analysis of clinical practice, B: what are the results and will they help me in caring for my patients? JAMA . 1997;;277:1802-1806.
49 +
Hayward RSA, Wilson MC, Tunis SR, Bass ER, Guyatt GH, for the Evidence-Based Medicine Working Group.  Users' guides to the medical literature, VIII: how to use clinical practice guidelines, A: are the recommendations valid? JAMA . 1995;;274:570-574.
50 +
Hayward RSA, Wilson MC, Tunis SR, Bass ER, Guyatt GH, for the Evidence-Based Medicine Working Group.  Users' guides to the medical literature, IX: how to use clinical practice guidelines, B: what are the results and will they help me in caring for my patients? JAMA . 1995;;274:1630-1632.
51 +
Cook DJ, Guyatt GH, Laupacis A, Sackett DL, Goldberg RJ.  Clinical recommendations using levels of evidence for antithrombotic agents . Chest . 1995;;108:227S-230S.
52 +
Browman G, Levine MN, Mohide A, et al.  The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation . J Clin Oncol . 1995;;13:502-512.
53 +
Eddy DM.  The challenge . JAMA . 1990;;263:287-290.
54 +
Pearson SD, Goulart-Fisher D, Lee TH.  Critical pathways as a strategy for improving care: problems and potential . Ann Intern Med . 1995;;123:941-948.
55 +
Schoenbaum SC, ed. Using Clinical Practice Guidelines to Evaluate Quality of Care . Washington, DC: US Dept of Health and Human Services; 1995;. Agency for Health Care Policy and Research publication 95-0045.
56 +
Fang E, Mittman BS, Weingarten SR.  Use of clinical practice guidelines in managed care physician groups . Arch Fam Med . 1996;;5:528-531.
57 +
The Diabetes Control and Complications Trial Research Group.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus . N Engl J Med . 1993;;329:977-986.
58 +
Hayward RSA, Wilson MC, Tunis SR, Guyatt GH, Moore KA, Bass EB.  Practice guidelines: what are internists looking for? J Gen Intern Med . 1996;;11:176-178.
59 +
Yandell B.  Critical paths at Alliant Health System . Qual Manage Health Care . 1995;;3:55-64.
60 +
Lomas J, Enkin M, Anderson GM, Hannah WJ, Vayda E, Singer J.  Opinion leaders vs audit and feedback to implement practice guidelines: delivery after previous cesarean section . JAMA . 1991;;265:2202-2207.
61 +
Soumerai SB, Avorn J.  Principles of educational outreach ('academic detailing') to improve clinical decision making . JAMA . 1990;;263:549-556.
62 +
Weingarten SR, Riedinger MS, Conner L, et al.  Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain . Ann Intern Med . 1994;;120:257-263.
63 +
Larsen RA, Evans RS, Burke JP, Pestotnik SL, Gardner RM, Classen DC.  Improved perioperative antibiotic use and reduced surgical wound infections through use of computer decision analysis . Infect Control Hosp Epidemiol . 1989;;10:316-320.
64 +
Tierney WM, Miller ME, Overhage JM, McDonald CJ.  Physician inpatient order writing on microcomputer work stations: effects on resource utilization . JAMA . 1993;;269:379-383.
65 +
Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM.  A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure . N Engl J Med . 1995;;333:1190-1195.
66 +
Greco PJ, Eisenberg JM.  Changing physicians' practices . N Engl J Med . 1993;;329:1271-1274.
67 +
Tunis SR, Hayward RSA, Wilson MC, et al.  Internists' attitudes about clinical practice guidelines . Ann Intern Med . 1994;;120:956-963.
68 +
Weingarten SR, Riedinger MS, Hobson P, et al. Evaluation of a pneumonia practice guideline in an interventional trial. Am Rev Resp Crit Care Med. In press.
69 +
Aucott JN, Pelecanos E, Dombrowski R, Fuehrer SM, Laich J, Aron DC.  Implementation of local guidelines for cost-effective management of hypertension . J Gen Intern Med . 1996;;11:139-146.
70 +
Fitzgerald JF, Smith DM, Martin DK, Freedman JA, Katz BP.  A case manager intervention to reduce readmissions . Arch Intern Med . 1994;;154:1721-1729.
71 +
Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M.  Comprehensive discharge planning for the hospitalized elderly: a randomized clinical trial . Ann Intern Med . 1994;;120:999-1006.
72 +
Katon W, Von Korff M, Lin E, et al.  Collaborative management to achieve treatment guidelines: impact on depression in primary care . JAMA . 1995;;273:1026-1031.
73 +
Weinberger M, Oddone E, Henderson WG, for the Veterans Affairs Co-operative Study Group on Primary Care and Hospital Readmission.  Does increased access to primary care reduce hospital readmissions? N Engl J Med . 1996;;334:1441-1447.
74 +
Lavizzo-Mourey R, Mackenzie ER.  Cultural competence: essential measurements of quality for managed care organizations . Ann Intern Med . 1996;;124:919-920.

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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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