The Emergence of Clinical Practice Guidelines

Weisz, George; Cambrosio, Alberto; Keating, Peter; Knaapen, Loes; Schlich, Thomas; Tournay, Virginie

doi:10.1111/j.1468-0009.2007.00505.x

Cited by 186 publications

(165 citation statements)

References 72 publications

Supporting

Mentioning

156

Contrasting

Unclassified

Order By: Relevance

“…Since the publication of the first coronary artery disease guidelines in the early 1960s, cardiology has been a leader in the development of clinical guidelines 1. In mid‐1990s, the American Heart Association and the American College of Cardiology published the first clinical guidelines for heart failure (HF) 2, 3.…”

Section: Introductionmentioning

confidence: 99%

Reasons for Guideline Nonadherence at Heart Failure Discharge

Gilstrap

Stevenson

Small

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundCardiology has advanced guideline development and quality measurement. Recognizing the substantial benefits of guideline‐directed medical therapy, this study aims to measure and explain apparent deviations in heart failure (HF) guideline adherence by clinicians at hospital discharge and describe any impact on readmission rates.Methods and ResultsThe extent of decongestion and prescription of neurohormonal therapy were recorded prospectively for 226 HF discharges, including 132 (58%) from an academic hospital and 94 (42%) from a community hospital. Among all discharges, 25% were discharged with residual congestion (30% academic versus 18% community, P=0.070). Among discharges of patients with HF with reduced ejection fraction, 37% (45% academic versus 18% community, P<0.001) were discharged without β‐blocker therapy or with lower doses than at admission. Moreover, 46% of patients with HF with reduced ejection fraction (48% academic versus 39% community, P=0.390) were discharged without an angiotensin‐converting enzyme inhibitor or angiotensin II receptor blocker or with lower doses than at admission. Renal dysfunction was the most common reason for discharge with congestion, and hypotension the most common reason for discharge with no or decreased neurohormonal therapy. There was a trend toward higher 90‐day readmission rates after discharge with residual congestion.ConclusionsClinicians frequently deviate from guidelines in both academic and community hospitals; however, this deviation may not always indicate poor quality. Application of guidelines recommended for stable populations is increasingly limited for hospitalized patients by hypotension, renal dysfunction, and inotrope use. Patients with renal dysfunction, hypotension, and recent inotrope use merit further study to determine best practices and possibly to adjust quality metrics for HF severity.

show abstract

Section: Introductionmentioning

confidence: 99%

Reasons for Guideline Nonadherence at Heart Failure Discharge

Gilstrap

Stevenson

Small

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…1,2 Unfortunately, guideline use is less than ideal as shown by population-based studies from several countries. [3][4][5] This is because of multiple, interacting contextual factors such as patient noncompliance, provider skepticism about guideline relevance for individual patients, lack of institutional infrastructure, and limited system-level resources and coordination.…”

mentioning

confidence: 99%

The development of guideline implementation tools: a qualitative study

2015

View full text Add to dashboard Cite

Background:Research shows that guidelines featuring implementation tools (GItools) are more likely to be used than those without GItools, however few guidelines offer GItools and guidance on developing GItools is lacking. The objective of this study was to identify common processes and considerations for developing GItools. Methods:Interviews were conducted with developers of 4 types of GItools (implementation, patient engagement, point-of-care decision-making and evaluation) accompanying guidelines on various topics created in 2008 or later identified in the National Guideline Clearinghouse. Participants were asked to describe the GItool development process and related considerations. A descriptive qualitative approach was used to collect and analyze data.Results: Interviews were conducted with 26 GItool developers in 9 countries. Participants largely agreed on 11 broad steps, each with several tasks and considerations. Response variations identified issues lacking uniform approaches that may require further research including timing of GItool development relative to guideline development; decisions about GItool type, format and content; and whether and how to engage stakeholders. Although developers possessed few dedicated resources, they relied on partnerships to develop, implement and evaluate GItools.Interpretation: GItool developers employed fairly uniform and rigorous processes for developing GItools. By supporting GItool development, the GItool methods identified here may improve guideline implementation and use. Abstract E128CMAJ OPEN, 3(1) Research CMAJ OPENwere not accompanied by implementation tools. [16][17][18] We interviewed 30 guideline developers from 7 countries who said that their target users had requested GItools, but they required direction for developing GItools. 19 Existing guideline development instructional manuals lack details on how to develop GItools. 20,21 The purpose of this study was to identify common processes and considerations for developing GItools. Methods ApproachGItool developers were interviewed to learn how they developed GItools. Qualitative research is useful for revealing tacit knowledge. 22 A descriptive qualitative approach was used along with various strategies to optimize rigor. 23,24 Consolidated criteria for reporting qualitative research 25 guided the reporting of study findings. Conduct of this study was approved by the University Health Network Research Ethics Board (12-0091-AE). Participants gave informed consent before being interviewed. Sampling and recruitmentThe National Guideline Clearinghouse (US Department of Health and Human Services, Agency for Healthcare Research and Quality; www.guideline.gov) was searched for Englishlanguage guidelines published in 2008 or later on the management of prevalent conditions that affect both men and women (e.g., arthritis, asthma, cancer, depression, diabetes, heart failure, stroke) and topics relevant to guideline developers who were collaborators on this research (e.g., chiropractic, dermatology, neurology, nephrol...

show abstract

“…1 Concern that just such a struggle might ensue is reflected in the original Medicare Act of 1965, which declared that "nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine." 6 In fact, considerable control has been exercised, although not specifically over the practice of medicine.…”

Section: The Value Culturementioning

confidence: 99%

“…Starting with only a handful in the late 1950s, their numbers increased sufficiently to prompt the establishment of a clearing house in the early 1990s. 1 Some conditions now have multiple guidelines, whereas others have none. Their use by physicians in the course of treatment decisions has proved to be invaluable.…”

Section: Introductionmentioning

confidence: 99%

“…The first standards were developed in the early 1900s to deal with matters such as tuberculosis prevention and radiation safety. 1 Over time, standards have been applied to many discrete therapeutic interventions and procedures, 2 and in recent years they have come to include checklists for defined processes. 3 Although guidelines have existed for millennia in authoritative texts, the form in which we know them today is comparatively recent.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation