Clinical care standards: appropriate care everywhere — acute coronary syndromes as an example

Abstract

Summary Audit data show that despite clinical practice guidelines, some patients miss out on evidence‐based care, which is not explained by individual needs or preferences. Clinical care standards are small sets of concise recommendations that focus on known gaps in evidence‐based care for a particular clinical condition. They aim to ensure that all patients with the same clinical condition are offered appropriate care, regardless of their location. Clinical care standards are nationally agreed standards and are developed to maximise engagement of consumers, clinicians, health services, and state and territory health departments and agencies. They complement clinical practice guidelines and other initiatives for improving quality of health care. As an example, the Acute Coronary Syndromes (ACS) Clinical Care Standard is a significant step forward in supporting clinicians and health services to realise all of the gains promised by the ACS evidence base. The ACS Clinical Care Standard focuses on the areas of care that are known to be most associated with variation in outcome. It supports patient involvement in critical decisions that affect their care, refocuses clinicians on the priority areas of ensuring appropriate ACS care, and informs health services about the systems required to deliver evidence‐based care.

Las “Vías Clínicas” como estrategia de mejoramiento en el manejo del Síndrome Coronario Agudo, una revisión narrativa.

“…Las vías clínicas se definen como planes interdisciplinarios y estructurados que buscan implementar las recomendaciones basadas en la evidencia científica a las estructuras locales de atención, detallando los pasos en una secuencia de tiempo, con el objetivo de estandarizar la atención de un problema clínico, procedimiento o episodio de atención especifico en una población (5) y son utilizadas en condiciones clínicas de relevancia, frecuencia e impacto poblacional como las enfermedades cardiovasculares. Estas son un conjunto de patologías suficientemente estudiadas y cuentan con recomendaciones basadas en la mejor evidencia para guiar la práctica clínica de forma estandarizada, eficaz y eficiente, a pesar de ello, múltiples estudios demuestran que no se logran estos objetivos (6,7); lo que reviste mayor importancia dada su alta frecuencia y mortalidad a nivel mundial y local.…”

Appropriateness of care: why so much variation

“…One way to deal with this is to use variation data to identify where change may appear warranted, and then focus on the development of mutually agreed standards of best practice care. Contributions in the Supplement reflect the important work that the ACSQHC has undertaken in this regard: Chew and colleagues describe the process for developing clinical care standards in Australia; 12 important examples are provided by Caplan and colleagues (cognitive impairment) 13 and Turnidge and colleagues (antimicrobial stewardship) 14 . However, as noted above, these need to be incorporated into broader micro and macro change strategies.…”