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Suggested Citation:"INDEX." Institute of Medicine. 1992. Guidelines for Clinical Practice: From Development to Use. Washington, DC: The National Academies Press. doi: 10.17226/1863.
×

Index

A.

Agency for Health Care Policy and Research budget. 56-57, 63

dissemination of guidelines, 190-191

education and dissemination strategies, 88

Forum for Quality and Effectiveness in Health Care, 46, 55, 56, 165 , 212

lessons learned in guidelines development, 165-166

medical review criteria development, 109

Medical Treatment Effectiveness Program, 56-57

Patient Outcomes Research Teams, 56-57, 179

responsibilities for guidelines, 2, 6, 55-57

review of guidelines, 172, 212

topic selection, 175

American Academy of Family Practice, 56

American Academy of Ophthalmology, 48, 169-170

American Academy of Pediatrics, 48, 56, 80, 188

American Board of Family Practice, 87, 101

American Board of Internal Medicine, 87

American Cancer Society, 87, 184

American College of Cardiology, 48-49, 170, 188, 288

American College of Emergency Physicians, 270

American College of Nuclear Physicians, 49

American College of Obstetricians and Gynecologists, 48, 49, 87

American College of Physicians, 184, 188, 275

Center for Applied Research, 52

Clinical Efficacy Assessment Project, 48, 52, 154 n.10, 166-167. 169

American College of Preventive Medicine, 51

American College of Radiology, 48, 49

American College of Surgeons, 264

American Dental Association. 47, 50

American Diabetes Association, 169-170

American Heart Association, 48-49, 170, 288

American Hospital Association, 102

American Medical Association assessment of guidelines, 213

Council on Scientific Affairs, 49

Diagnostic and Therapeutic Technology

Assessment program, 49

''Do Not Resuscitate" guidelines, 28

listings of guidelines, 189

practice guidelines development, 49, 51, 60, 169

Practice Parameters Forum, 49, 60, 169

Specialty Society Partnership, 49, 60, 169

American Medical Center Consortium, 60

American Medical Peer Review Association, 108

Suggested Citation:"INDEX." Institute of Medicine. 1992. Guidelines for Clinical Practice: From Development to Use. Washington, DC: The National Academies Press. doi: 10.17226/1863.
×

American Medical Record Association, 102 n.2

American Medical Review Research Center, 55, 109

American Nurses Association, 47, 50

American Society for Testing and Materials, 92, 311

American Society of Anesthesiology, 48, 49, 51, 74

American Society of Internal Medicine, 172

Anesthesiology guidelines, 48, 49, 51, 74, 125, 130, 131

Appropriateness of care, 5, 27

cost-effectiveness considerations, 143-144

definition, 28, 33, 154, 155

distinguished from practice guidelines, 60

instruments for determining, 57

as practice policies, 33

precertification of services, 41

purpose of, 60

RAND Corporation criteria, 36, 60

research findings on, 37

Assessment instrument, 19, 173, 209-210

attributes of practice guidelines, 350, 364-404

background, 362-364

clarity, 394-397

clinical applicability, 365-367

clinical flexibility, 368-371

development process, 348-350

ideal, 355-356

multi-disciplinary process, 400-404

pretesting and experience with, 359

purposes of, 347-348

question and response categories, 351-353

reliability/reproducibility, 372-374

response aggregation and display, 354

response scoring, 353-354

scheduled review, 398-399

summary evaluation sheet, 405-410

supporting material for guidelines, 357-358

users, 356

validity, 375-393

Assessment of practice guidelines, 199

AMA attributes for, 49

benefits of, 208-209

clinical trials, 192, 217

computer applications in, 90

cost considerations in, 62

credibility, 215

draft reviewers, 171-173, 193-194, 213

feasibility of, 211-215

focus groups, 167, 192

funding, 20, 214-215

IMCARE Guidelines Network, 172-173

and legal weight of guidelines, 133

organization for, 19-20, 210-215

peer review, 172

program components, 18

publication for, 20, 213-214

surveys, 192

training in, 86

Attributes of practice guidelines, 7, 8, 28-30

medical review criteria, 7, 8, 9, 111-112

B

Benefit coverage basic benefits, 13, 154, 156

decision making aid, 169

descriptions, 115, 156

disclosure requirements, 150

exclusions/restrictions, 27, 114-115, 150, 151, 154-155, 156

implementation of practice guidelines, 5, 16, 22, 27, 41, 61, 70-71, 79, 113-119

and liability, 114 n.8, 132 n.23

medical review criteria and, 115-116

patient preferences and, 158

priority setting, 158-159

reforms related to, 22

types of decisions, 114-115

Benign prostatic hypertrophy, 55, 109, 179, 181

Blood transfusions, 34, 73, 158, 306

Blue Cross and Blue Shield Association, 60-61, 113, 154, 156, 169

Board certification, 86-87

Breast cancer, 59, 140, 181, 182 n.8, 184

Brigham and Women's Hospital, 93

C

Canada, College of Family Physicians, 101

Canadian Task Force, 173-174, 178

Cardiac technologies, 108, 170

Cardiovascular care, 48, 54, 56, 60

Carotid endarterectomy, 60, 108, 280

Cataract surgery, 60, 108

Center for Health Economics Research, 56

Centers for Disease Control, 54-55, 260

Chest pain management, 170, 270

Children's Hospital (Pittsburgh), 56

Cholesterol screening, 35, 54, 59

Suggested Citation:"INDEX." Institute of Medicine. 1992. Guidelines for Clinical Practice: From Development to Use. Washington, DC: The National Academies Press. doi: 10.17226/1863.
×

Clinical practice guidelines applications, 2, 8, 14-18, 23, 30, 40 , 196-197

see also Implementation of practice guidelines appropriateness criteria distinguished from, 60

as benchmarks for performance, 15, 73, 96, 110

clarity of, 8, 30, 394-397

and clinical flexibility, 8, 30, 368-371

clinically oriented, 36

complexity, 36

content, 29, 32, 74-75, 104

context for understanding, 2, 24

and cost containment, 2, 3-4, 21, 23, 36-37, 99;

see also Cost management

credibility of, 5, 11, 45, 198

defined, 2-3, 26-27

distinguished from reimbursement or coverage policies, 2-3

educational opportunities in, 10

evaluation of impact of, 6

expectations about, 4, 23, 24, 38-39, 42-43

fears about misuse of, 23-24

funding for, 5

and health care reform, 21-22

and informed patient decision making, 2, 32

legal implications, 49-50;

see also Medical malpractice

limitations of current efforts, 6, 10, 42, 199

policy makers' interests in, 3-4, 5, 23, 27, 36-39, 198

presentation of, 10

and quality of care, 23, 99

reliability/reproducibility, 8, 30, 372-374

research needs, 24, 174-183

scheduled review, 398-399

statutory recognition of, 17-18, 207

strengths of current efforts, 5-6, 198

study committee membership and

activities, 25-26

study objectives, 1-2, 25-26

translation into medical review criteria, 6, 40, 56, 107

types of, 36

users, 3, 36, 38, 40-41

validity, 8, 29, 30, 375-393

variations in, 243-244

see also Development of practice guidelines

Clinical trials of clinical alert/reminder system, 91

weight of scientific evidence from, 178

Common Diagnostic Tests,143, 169, 275

Common Screening Tests,143, 169

Computers/computerization, 24

access to information, 93, 94

advances in, 92-93

and application of guidelines, 18

ARDEN syntax, 92-93

assessment of guidelines, 90

CD-ROM disks, 94 n.4

clinical reminders and alerts, 73, 90-91, 95

compatibility/linkages between systems, 9, 92-93, 94, 97

constraints on, 91-92

costs, 92

current systems, 90-92

data collection and analysis strategies, 93

decision support, 93, 94-95

and development of guidelines, 93-94

directions for, 96-98

dissemination of guidelines, 90, 188-190, 208

educational applications, 89

impacts of, 91

information systems, 90-94, 96-98

integrated data bases, 73, 95-96

interactive videos, 89, 181, 194

Medical Logic Module, 311

medical records, 73, 90, 92, 95, 97, 140

medical review criteria algorithms, 109-110

National Library of Medicine, 18, 94, 96-97, 165, 188, 189, 191, 208

outcomes data, 95

quality improvement programs, 72-74, 102 n.2, 140

review and revision of guidelines, 95, 95

self-teaching modules, 88

translation of guidelines for use on, 92-93, 97, 182, 208

Uniform Clinical Data Set, 58

user-friendliness, 80-81, 92, 207-208

voice recognition systems, 81, 93, 97

Conflicting guidelines, 35, 183-184

Congestive heart failure, 56, 166

Continuous quality improvement, 5

administrative focus of, 104-105

Suggested Citation:"INDEX." Institute of Medicine. 1992. Guidelines for Clinical Practice: From Development to Use. Washington, DC: The National Academies Press. doi: 10.17226/1863.
×

deficiencies in, 111

feedback to physicians, 103, 105

by hospitals, 102

implementation of medical review criteria in, 107

implementation of practice guidelines in, 2, 15, 62, 70-74, 103-104, 205-206

JCAHO implementation of, 102

liability problems, 134

as a management strategy, 72-74

models, 102-103, 205-206

principles, 103, 105-106

testing and modification of guidelines, 10, 24

Coronary artery bypass surgery, 49, 60, 105, 170, 323

Cost management benefit coverage determinations. 5, 16, 70, 113-119

consumer incentives, 122

credentialing and selection of practitioners, 16, 119-121

development of guidelines, 7, 12-13, 21-22, 32, 52, 80, 140-146

economic incentives, 16, 121-122

implementation of practice guidelines for, 2, 3-4, 16-17, 21, 36-37, 38-39, 41, 42, 70-71, 135, 140-146, 206-207

incentives for economy and efficiency, 39, 121-122, 123

integrated financial and clinical

management computer systems, 95-96

medical review criteria and, 115-116, 206

prior review and, 115-116

proposed directions for, 123

tort liability concerns, 116-119

utilization review and, 116

Costs of health care defensive medicine, 125 n.17

and health benefits, 3, 37

implications included in guidelines, 12-13, 21-22, 135-136, 140-146

and minimum levels of care, 12-13

Council of Medical Specialty Societies, 49, 168

Coverage, see Benefit coverage

Critical pathways, 75, 105, 186-187

D

Decision modeling, 48

Definitions and terminology appropriateness of care, 28. 33, 154, 155

"basic benefits,"; 13, 154-157

clinical practice guidelines, 2-3, 26-27

concerns about, 155-156

"guidelines,"; 33

"indicated,"; 154

"medical necessity,"; 13, 154-155, 160

medical review criteria, 2, 27

"minimum care,"; 12-13, 154, 157-159

"necessary,"; 154-157

"options for care,"; 33

"standards for care,"; 33, 127, 133

"strong evidence,"; 33

Development of practice guidelines algorithms, 61-62, 181

analytic strategy, 29, 31-32

appropriateness criteria converted into, 60

assumptions about, 4, 38

attributes of guidelines considered in, 29, 49, 111, 116

benefit-harm determinations of alternative

courses of care, 31

building a compelling case for

recommendations, 7-10, 200

chairperson, 165

clinician participation in, 15

computer applications for, 93-94

consensus approaches, 33-34, 54, 60, 61, 63, 164, 166-168, 176

cooperative actions in, 48-49, 60-61, 168-170

cost-effectiveness considerations, 7, 12-13, 21-22, 32, 52, 80, 140-146

costs of, 62-63, 165, 181, 199, 203-204

desirable attributes of, 7, 8, 28-30

dissemination concerns, 168 n.3

documentation of, 8, 30, 45, 47 n.2, 90, 132, 136, 144, 168 n.3

evidentiary foundation, 4, 7, 24, 29, 31, 32-35, 38, 45, 104, 126, 132, 136, 145, 164, 168 n.3, 178-179

funding for, 5, 56, 60, 61

and implementation of guidelines, 7, 11-12, 45-46, 163-164, 183-192, 201-203

improvements in, 6-14, 199-204

inconsistency and confusion in, 11, 13, 26-27, 28, 35, 76-77, 181-183, 202

see also Definitions and terminology

liability considerations, 116-117, 118-119

literature searches, 54, 139, 165, 178

minimum levels of care, 12-13, 153-154, 157-160. 203-204

Suggested Citation:"INDEX." Institute of Medicine. 1992. Guidelines for Clinical Practice: From Development to Use. Washington, DC: The National Academies Press. doi: 10.17226/1863.
×

multidisciplinary process, 9, 30, 45, 167

organizational processes, 164-170, 176-178

and outcomes research, 7, 167

panel creation and member selection, 170-171, 176-178

patient preferences considered in, 31, 68-69. 148-150, 151, 167, 180-181, 199

payer interest in, 112-113

pluralism and diversity in, 5, 6, 42, 46-47, 181-182, 198, 199

priority setting in, 57, 104, 175-176

by private-sector organizations, 59-62

by professional organizations, 1, 5, 46-52

by public agencies, 52-59;

see also individual agencies

quality control in, 6, 16, 199

quantitative/modeling approach, 176

and research targeting, 35

resources for, 6

revision/updating, 8, 30, 32, 35, 38, 45, 90, 95, 168 n.3, 173-174

substantive content, 7, 8, 32

"sunset" provisions, 173

terminology, 13, 26-27, 28

testing and modification, 10, 20;

see also Assessment of practice guidelines

time commitment, 165

training for, 168

volume of efforts, 39, 42, 163-164

see also Formats of guidelines:

Local adaptation of guidelines;

Methodological issues

Diabetic retinopathy, 169-170

Dietary cholesterol recommendations, 32

Dysuria, 333

E

Education computer applications in, 88, 89

conferences for guideline users, 16, 110-111

evaluation of programs, 109

impact and cost-effectiveness, 88-89

implementation of practice guidelines in, 67, 72-74, 78, 86-90

informal processes, 89

interactive videos, 89, 181, 194

on needs of patients, 89

operations-level feedback, 88, 110

opportunities in development of practice

guidelines, 10

outreach programs, 55

patient, 41, 87, 89, 147

personal, interactive strategies, 88

of practitioners, 16, 88, 109, 110, 123

reimbursement for, 89

small-group strategy, 88

training in assessment of guidelines. 84

training of guidelines developers, 168

Emergency room care, 125, 130, 131, 170, 270

End-stage renal disease. 31 n.6

Erythrocyte sedimentation rate tests in diagnosis, 275

Ethical concerns cost-effectiveness considerations, 145-146

information provision to patients, 150-153

informed consent, 138. 147-148

and minimum care and basic benefits, 154-160

obligations of collective social systems. 138-140

obligations of individuals, 136-138

paternalism, 137-138

patient autonomy, 137, 148, 149

patients in persistent vegetative states, 149

terminally ill patients, 138, 149

F

Food and Drug Administration, 53

Formats of guidelines, 167

algorithms, 247-248, 270, 333

computer-based, 73, 189, 251, 296, 311, 317

critical pathways, 323

defined, 36

and dissemination, 12, 188-189, 202-203

formalized presentations, 246-251

flowcharts and similar styles, 248-249, 264, 311, 317, 321

free text, 245-246, 252, 260, 264, 270, 275, 280, 288, 296, 306, 328, 336

standards proposed, 249-251

G

Group Health Cooperative of Puget Sound, 139-140, 186

H

Harvard Community Health Plan Clinical Guidelines Program, 61-62, 333

computer link to Brigham and Women's Hospital, 93

Suggested Citation:"INDEX." Institute of Medicine. 1992. Guidelines for Clinical Practice: From Development to Use. Washington, DC: The National Academies Press. doi: 10.17226/1863.
×

Health care institutional implementation of guidelines, 67, 74-76

minimum levels of, 12-13, 139

rationing of, 139

reforms, 21-22, 135, 156-157, 217-219

"two-tier,"; 160

Health Care Financing Administration, 57-58, 60, 108, 179 n.5

Health examinations, periodic, 59

Health insurance competition and consumer choice among plans, 22, 131-132

deductibles and cost sharing, 121

practice guidelines as mechanism for defining, 5

right to information on treatment options, 150-151

see also Benefit coverage

Health maintenance organizations, practice guidelines, 61-62, 67, 113

Health status assessment, 179-180

Holston Valley Hospital, 323

Hospitals clinical pathways or protocols, 105

continuous quality improvement by, 102, 105

implementation of practice guidelines, 74-75, 78, 79

retrospective utilization review programs, 115

Human immunodeficiency virus, universal precautions, 27-28

Hypertension screening, 31 n.6, 54

Hypertension treatment program, 89

I

Immunization practices, 54, 55, 59, 151, 182 n.8, 260

Implementation of practice guidelines, 25

by academic medical center hospital, 72-74, 78

in ambulatory care, 62, 68

and behavioral change, 14, 72-74

case studies, 67-77

in certification and re-certification of physicians, 86-87, 101

challenges to, 65-77

clinical research role, 84

by community hospitals, 74-75, 78, 79

conditions for success in, 14-18, 84-85

context considerations, 84

continuous quality improvement applied to, 104

in cost management, 16-17, 27, 36-37, 38-39, 41, 70-71, 99-100, 112-123, 135, 206-207

in credentialing of practitioners, 119-120

dissemination strategies, 12, 54, 87, 94, 170, 188-192, 203

economic factors, 72-75, 79

educational conferences for users, 16, 110-111

for educational purposes, 41, 72-74, 78, 86-90

environmental factors in, 79

format and specificity and, 68-69

"hassle" factor, 68-69, 116

and human errors, 76-77

information and decision support systems, 18, 68-69, 72-74, 80-81, 207-208

institutional factors in, 78-79

interface between development and, 11-12, 45-46, 78, 163-164, 201-203

in internal medicine practice. 68-69

by managed care organization, 70-71, 79

in management decision making and follow-through, 74-75

medical liability and, 41, 51, 67, 74-75, 125-132, 207-208

by nurses and nurse-practitioners, 40

by nursing homes and hospices, 75-76, 78, 79

patient needs, characteristics, and

preferences and, 68-69, 74-75, 78, 79, 145

by patients, 39, 40, 76-77, 78, 87, 89

by physicians/practitioners, 23, 40, 41, 66, 67, 78, 153-154

practice variation and, 72-74

for preventive services, 139-140

in quality assurance and improvement, 2, 15-16, 27, 37, 41, 72-74, 205-206

regulation and interpretation of guidelines, 75-76

requirements for. 42

in risk management, 17-18, 37, 41, 51, 74-75, 100, 207-208

strategies to encourage, 79-81, 87

tasks, 65

time constraints, 68-69

training programs, 110

Incentives, economic, 72-75

Suggested Citation:"INDEX." Institute of Medicine. 1992. Guidelines for Clinical Practice: From Development to Use. Washington, DC: The National Academies Press. doi: 10.17226/1863.
×

Inconsistent guidelines, 35, 183-184

Independent practice associations, 67, 121

Information systems, see Computers/ computerization

Informed consent, 15, 103

British standard, 147 n.6, 151 n.8

defined, 147

ethical concerns, 138

guidelines for, 28, 152-153

and patient preferences, 147, 151-152

and risk management, 147

Informed patient decision making, 2, 5

as a goal of practice guidelines, 15, 23, 32, 41, 103, 125

guidelines for, 13-14, 28, 152-153, 204

and informed consent, 148

patient preferences and, 145, 148-150

responsibilities for provision of

information, 151-152

risk management and, 125

Intermountain Health Systems (Salt Lake City), 96

Internal Medicine Center to Advance Research and Education, 172-173

Internal medicine practice, 68-69, 78

International Society for Technology

Assessment in Health Care, 168 n.3

Interstudy, Outcomes Management System, 120-121, 179 n.5

J

John A. Hartford Foundation, 60, 166, 168

Johns Hopkins University Program for Medical Technology and Practice Assessment , 86

Joint Commission on Accreditation of Health care Organizations, 28 , 71, 102

K

Kaiser Permanente, 62

L

Labor and delivery after previous cesarean section, 296

Latter Day Saints Hospital (Salt Lake City), 91

Litigation benefit coverage, 114 n.8

Helling v. Carey,128 n.21

medical liability, 114 n.9, 117

Pirozzi v. Blue Cross and Blue Shield of Virginia,114 n.8, 117 n.11

Rollo v. Blue Cross-Blue Shield of New Jersey,117 n.11

Salgo v. Leland Stanford Junior University Board of Trustees,147

Wickline v. California,114 n.9, 117, 118

Wilson v. Blue Cross of California,114 n.9, 118

Local adaptation of guidelines case studies, 70, 72-74, 75-76

and conflict and inconsistency, 183-184

evidentiary foundation of guidelines and, 32

processes for, 6, 186-187, 199, 202

reasons for, 11-12, 184-186, 202

and stature of guidelines, 187-188

Low back pain, 181, 321

M

Maine, medical liability demonstration project, 130

Managed care organization, 70-71, 79

Maryland Hospital Association, quality indicator project, 102

Massachusetts General Hospital (Boston), 91

Massachusetts, risk management strategy, 131, 270

Mayo Clinic, 60

Medicaid. 113, 117

length-of-stay criteria, 118

Oregon reforms, 157

Medical malpractice continuous quality improvement models and, 134

contract language for HMOs, 132 n.23

cost management and, 17, 114

customary practice, 127

decision making reforms, 22

"defendent use only" aspect of guidelines, 130-131, 133

and defensive medicine, 125 n.17, 126

defined, 127-128

duty of care, 117-118

hearsay evidence, 128

immunity from liability, 17, 117 n.11, 128, 129, 130, 132, 133, 187 , 207

implementation of practice guidelines and, 41, 51, 67, 74-75, 100, 125, 126

informed consent and, 147

insurance premiums, 51, 125, 131

"learned treatises,"; 128

local adaptation of guidelines and, 187-188

negligence standard, 117, 118, 125, 153, 159

Suggested Citation:"INDEX." Institute of Medicine. 1992. Guidelines for Clinical Practice: From Development to Use. Washington, DC: The National Academies Press. doi: 10.17226/1863.
×

physician responsibility for care, 118

reform issues, 126, 131-132

research on. 133

standard-of-care determinations, 127, 128-132

"strict locality rule" and "similar locality rule."; 127

underwriters' development of guidelines, 51

variation in, 58

weight of guidelines in decision making on, 17, 128-132, 207

see also Litigation:

Risk management

Medical necessity, 13

Medical review criteria appeals criteria, 9, 112

and benefit cost management, 115-116

computerization. 9, 109-110, 112

criticisms of, 17, 58, 69, 107-108, 116, 207

defined, 2, 27

desirable attributes of, 7, 9, 17, 28, 111, 112, 116, 123, 206

development of, 107, 109-110

evaluation of, 109

feasibility, 9, 112

implementation issues. 107-108

obtrusiveness. 9, 112

patient responsiveness to, 9, 112

patterns-of-care focus, 107

private sector implementation, 109-110

public sector implementation of, 108-109

readability, 9, 112

sensitivity of, 9, 112

specificity of, 9, 112

translation of practice guidelines into, 6, 55-56, 107, 199

Medicare, 113

carriers and fiscal intermediaries, 107

controls on payments, 37

defensive medicine costs, 125 n.17

medically necessary care standard, 155, 159

reimbursement policies, 27, 156

Medicare Peer Review Organizations (PROs) criticisms of, 132

defined, 57-58

implementation of practice guidelines, 67

liability of, 129

review criteria, 17, 55, 58, 107-108, 133

utilization review activities, 108

The Merck Manual,62

Metabolic acidosis, 311

Methodological issues, 200-201

algorithmic analysis, 182

analytical strategy for guidelines

development, 29, 31-32

committee focus, 10-11, 142

conflicts and inconsistencies in guidelines, 181-183

cost-effectiveness analysis and estimation, 141-142

evaluation of scientific evidence, 178-179

expert panel processes, 176-178

patient preferences incorporated into

guidelines, 180-181

problems, 39

research needs, 174-183

topic selection, 175-176

Micromanagement of professional and institutional behavior, 17, 23 , 123

Minimum Care, 154-159

Minnesota Clinical Comparison and Assessment Project, 61

N

National Cholesterol Education Program for Adults, 54

National Demonstration Project on Quality Improvement in Health Care , 102

National Heart, Lung, and Blood Institute, 54

National High Blood Pressure Education Program, 54

National Institutes of Health Consensus Development Conference Program , 54, 167-168, 175

Office of Medical Applications in Research, 53-54. 63, 167

National Library of Medicine (NLM), 18, 27, 94, 96-97, 165, 188, 189, 191, 208, 214

New England Medical Center hospitals (Boston), 96, 323

Nursing homes and hospices, 75-76, 78, 79, 138-139

O

Obstetrics and gynecology guidelines, 48, 49, 87, 130

Office for Health Services Research Information, 18, 208

Office of Health Technology Assessment, 176

Suggested Citation:"INDEX." Institute of Medicine. 1992. Guidelines for Clinical Practice: From Development to Use. Washington, DC: The National Academies Press. doi: 10.17226/1863.
×

Office of Technology Assessment, 59

Omnibus Budget Reconciliation Act of 1989, 55, 56, 65 n.1, 94, 175 , 179

Oral contraceptives, 317

Oregon Basic Health Services Act, 157

Otitis media in children, 56, 166

Outcomes of care, 5

assessment of, 7, 29, 110

continuous quality improvement and, 104

incorporation in practice guidelines, 179-180

Interstudy Outcomes Management System, 120-121

methodologic concerns, 179-180

patient preferences, 148

in patient satisfaction surveys, 15, 103

practice guidelines and, 15, 95, 100

research on, 5, 37-38, 42, 56-57

uncertainties about, 37-38

P

Pain management, 55, 76, 109, 170, 191 n.,11, 270, 336

Patients autonomy, 137, 138, 148-150

economic incentives for cost containment, 16

education, 41, 87, 89, 147

guidelines content for, 32, 252, 260, 296, 306, 321

implementation of practice guidelines, 39, 40, 66, 67, 76-77, 78, 79, 87

information on cost control incentives, 121-122

noncompliance with treatment regimen, 89

preferences, 29, 31, 103, 145, 147, 148-150, 158, 180-181

satisfaction with care, 15, 103

see also Informed patient decision making

Peer Review Organizations, see Medicare Peer Review Organizations

Pew Memorial Trust, 60

Physician-patient relationship, 89, 138

Physician Payment Review Commission, 49

Physicians availability of computer-based information systems, 93

behavioral change, 72-74, 85, 88

certification and re-certification of, 86-87, 101

feedback to, 70-71, 72-74, 88, 103, 105, 110, 123, 172

implementation of guidelines, 23, 40. 41. 66, 67, 78, 153-154

licensure conditions, 131

practice patterns, 72-74, 85

see also Practitioners

Physicians' Desk Reference,62, 69, 76

Poststroke rehabilitation, 56, 166

Practitioners attitudes about prior review programs, 115-116

autonomy concerns, 24, 66

credentialing, 16, 119-120

economic incentives for cost containment, 16

educational strategies for, 88, 109

ethical obligations to patients, 136-137

objections to practice guidelines, 24

performance evaluation, 61

sanctions against, 110, 120

selective contracting, 16, 120-121

self-regulation, 17, 123

variations in practice patterns, 37

Preferred provider organizations, 113, 121

President's Commission for the Study of Ethical Problems in Medicine and Bio- medical and Behavioral Research, 147

Pressure sores, prevention, 75

Preventive interventions, 58-59, 71, 139-140, 158

Prior review programs, 115

Professional organizations development of guidelines. 1, 5, 6, 47-52. 168-170

focus of. 47

interests in practice guidelines, 50-52

journals, 47, 49

see also individual organizations

Prospective preprocedure and preadmission criteria, 17. 58, 109, 206

Psoriasis, 328

Public Law 92-703, 129

Q

Quality assessment. 5, 41, 107

Quality assurance Appropriateness Evaluation Protocol. 57

benchmarks for performance, 15

chart audits, 101, 105

conceptual framework, 101

educational strategies and, 87

evaluations of performance and outcomes

data, 16

Suggested Citation:"INDEX." Institute of Medicine. 1992. Guidelines for Clinical Practice: From Development to Use. Washington, DC: The National Academies Press. doi: 10.17226/1863.
×

feedback to practitioners, 16

implementation of practice guidelines for, 37, 41, 205

proposed directions for, 110-111

revision/updating of guidelines, 16

tests of clinical skills, 101

see also Continuous quality improvement

Quality control, in guidelines development, 6

Quality improvement, see Continuous quality improvement;

Total quality management

Quality of care defined, 100

management commitment to, 103

practice guidelines and, 23, 99, 100

R

Radiology guidelines, 48, 49, 130

RAND Corporation, 36, 56, 57. 60, 109, 155, 169, 280

Regenstrief Medical Record System, 90

Reimbursement, 74, 89

Report on Medical Guidelines & Outcomes Research,189

Research agenda adoption and diffusion of medical innovations, 21, 35, 216

assessment instrument, 21

conflicts and inconsistencies in guidelines, 181-183, 216

expert panel processes, 176-178, 216

impact of practice guidelines, 21, 35, 104, 216-217

incorporating outcomes information into guidelines, 179-180

medical liability, 133

methodologies for evaluating scientific evidence, 178-179, 216

on outcomes and effectiveness of health care services. 3, 24, 38, 42, 56-57, 104, 215-216

patient preferences, 180-181

testing effectiveness of practice guidelines, 21, 216

topic selection, 175-176

Retrospective review of care, 17

Risk management computer applications in, 95

educational strategies and, 87

implementation of practice guidelines in, 17-18, 37. 41, 51, 74-75, 100, 124-125

informed consent and, 147

physician conditions of licensure, 131

see also Medical malpractice

Robert Wood Johnson Foundation, 60, 102

Scientific American Medicine,62

Selective contracting, 70-71

Society for Medical Decision Making, 50

Society of Nuclear Medicine, 49

Standards for care, 33, 56

Sweden, clinical practice guidelines, 35

T

Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures, 48-49

Terminology, see Definitions and terminology

Third-party payers implementation of practice guidelines by, 5, 16 , 22, 27, 41

liability for negligence, 117

Total quality management, 102, 104-105

Triage of injured patients, 145, 264

U

United Health Care, 62

Universal precautions, 27-28

Urinary incontinence, 55, 109, 333

U.S. Health Care, 62

U.S. Preventive Services Task Force, guidelines, 34, 58-59, 63, 172 , 252

U.S. Public Health Service, guidelines development, 53-57, 143, 172

Utilization review appropriateness criteria, 57

concurrent review of inpatient care, 115, 117

and cost control, 116

criticisms of, 107-108

by hospitals, 115

implementation of practice guidelines, 116, 206-207

liability, 114 n.9, 117-119

medical review criteria in, 107

by PROs, 57-58, 108, 129

retrospective, 115

role of, 17, 70-71, 101, 123, 207

by third-party payers, 115

V

Vaccinations for pregnant women, 55, 260

Value Health Sciences, 60

definition of appropriate care, 155

Medical Review System, 109

Visual acuity screening of children, 59, 252

W

Wishard Memorial Hospital, 90

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Guidelines for the clinical practice of medicine have been proposed as the solution to the whole range of current health care problems. This new book presents the first balanced and highly practical view of guidelines—their strengths, their limitations, and how they can be used most effectively to benefit health care.

The volume offers:

  • Recommendations and a proposed framework for strengthening development and use of guidelines.
  • Numerous examples of guidelines.
  • A ready-to-use instrument for assessing the soundness of guidelines.
  • Six case studies exploring issues involved when practitioners use guidelines on a daily basis.

With a real-world outlook, the volume reviews efforts by agencies and organizations to disseminate guidelines and examines how well guidelines are functioning—exploring issues such as patient information, liability, costs, computerization, and the adaptation of national guidelines to local needs.

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