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ARTICLE |

Translating Good Advice Into Better Practice FREE

Thomas H. Lee, MD, MSc; Herbert L. Cooper, MD
[+] Author Affiliations

Reprints: Thomas H. Lee, MD, MSc, Partners Community HealthCare, Inc, Suite 1150, Prudential Tower, 800 Boylston St, Boston, MA02199(e-mail: thlee@bics.bwh.harvard.edu).


JAMA. 1997;278(23):2108-2109. doi:10.1001/jama.1997.03550230084043
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The filing cabinets of physicians today are bulging with practice guidelines that have been derived from different organizations for various purposes. Some of these guidelines attempt to define appropriate and inappropriate care, while others seek to standardize how medical tasks are performed. These latter guidelines often take the form of "critical paths"1 that set ambitious goals for length of stay or clinical processes, such as time to treatment with thrombolytic therapy.2

See also p 2075.

Regardless of their nature, the true goal of guidelines should be to improve care—meaning better patient outcomes or increased efficiency, or both. Unfortunately, our strong suspicion is that most guidelines that reach physicians' filing cabinets remain there. Only a handful of guidelines have been shown to have a beneficial impact on patient care,3 and research evaluating the impact of guidelines has shown decidedly mixed results.5-7

Few physicians would challenge the credibility

REFERENCES

Pearson SD, Goulart-Fisher D, Lee TH.  Critical pathways as a strategy for improving care . Ann Intern Med . 1995;;123:941-948.
National Heart Attack Alert Program Coordinating Committee 60 Minutes to Treatment Working Group. Emergency Department: Rapid Identification and Treatment of Patients With Acute Myocardial Infarction. Washington, DC: National Heart, Lung and Blood Institute, Public Health Service, US Dept of Health and Human Services; September 1993. NIH publication 93-3278.
Weingarten S.  Practice guidelines and prediction rules should be subject to careful clinical testing . JAMA . 1997;;277:1977-1978.
Weingarten S, Riedinger M, Conner L, et al.  A utilization management practice guideline to reduce hospital costs for chest pain patients: a prospective controlled interventional trial . Ann Intern Med . 1994;;120:257-263.
Lee TH, Pearson SD, Johnson PA, et al.  Failure of information as an intervention to modify clinical management . Ann Intern Med . 1995;;122:434-437.
Corey GA, Merenstein JH.  Applying the acute ischemic heart disease predictive instrument . J Fam Pract . 1987;;25:127-133.
Weingarten SR, Riedinger MS, Conner L, et al.  Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain: an interventional trial . Ann Intern Med . 1994;;120:257-263.
Stiell IG, Greenberg GH, Wells GA, et al.  Derivation of a decision rule for the use of radiography in acute knee injuries . Ann Emerg Med . 1995;;26:405-413.
Stiell IG, Greenberg GH, Wells GA, et al.  Prospective validation of a decision rule for the use of radiography in acute knee injuries . JAMA . 1996;;275:611-615.
Stiell IG, Wells GA, Hoag RH, et al.  Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries . JAMA . 1997;;278:2075-2079.
Davis DA, Thomson MA, Oxman AD, Haynes B.  Changing physician performance: a systematic review of the effect of continuing education strategies . JAMA . 1995;;274:700-705.
Martin AR, Wolf MA, Thibodeau LA, Dzau V, Braunwald E.  A trial of two strategies to modify the test-ordering behavior of medical residents . N Engl J Med . 1980;;303:1330-1336.

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Pearson SD, Goulart-Fisher D, Lee TH.  Critical pathways as a strategy for improving care . Ann Intern Med . 1995;;123:941-948.
National Heart Attack Alert Program Coordinating Committee 60 Minutes to Treatment Working Group. Emergency Department: Rapid Identification and Treatment of Patients With Acute Myocardial Infarction. Washington, DC: National Heart, Lung and Blood Institute, Public Health Service, US Dept of Health and Human Services; September 1993. NIH publication 93-3278.
Weingarten S.  Practice guidelines and prediction rules should be subject to careful clinical testing . JAMA . 1997;;277:1977-1978.
Weingarten S, Riedinger M, Conner L, et al.  A utilization management practice guideline to reduce hospital costs for chest pain patients: a prospective controlled interventional trial . Ann Intern Med . 1994;;120:257-263.
Lee TH, Pearson SD, Johnson PA, et al.  Failure of information as an intervention to modify clinical management . Ann Intern Med . 1995;;122:434-437.
Corey GA, Merenstein JH.  Applying the acute ischemic heart disease predictive instrument . J Fam Pract . 1987;;25:127-133.
Weingarten SR, Riedinger MS, Conner L, et al.  Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain: an interventional trial . Ann Intern Med . 1994;;120:257-263.
Stiell IG, Greenberg GH, Wells GA, et al.  Derivation of a decision rule for the use of radiography in acute knee injuries . Ann Emerg Med . 1995;;26:405-413.
Stiell IG, Greenberg GH, Wells GA, et al.  Prospective validation of a decision rule for the use of radiography in acute knee injuries . JAMA . 1996;;275:611-615.
Stiell IG, Wells GA, Hoag RH, et al.  Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries . JAMA . 1997;;278:2075-2079.
Davis DA, Thomson MA, Oxman AD, Haynes B.  Changing physician performance: a systematic review of the effect of continuing education strategies . JAMA . 1995;;274:700-705.
Martin AR, Wolf MA, Thibodeau LA, Dzau V, Braunwald E.  A trial of two strategies to modify the test-ordering behavior of medical residents . N Engl J Med . 1980;;303:1330-1336.
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To understand the clinical management of acute heart failure syndromes.
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