Managed Care Systems and Emerging Infections Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention: Workshop Summary (2000) / Chapter Skim
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3 Clinical Practice Guidelines
3 Clinical Practice Guidelines
Pages 25-32
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From page 25... ...
The presentations described below examine the challenges and opportunities related to clinical practice guidelines, managed care, and emerging infections. CLINICAL PRACTICE GUIDELINES FOR EMERGING INFECTIONS AND MANAGED CARE Presented by Anne Schuchat, M.D.
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From page 26... ...
Managed care may also be a contributing factor, particularly as more of the at-risk populations for new and reemerging infections are inrI'~A~1 under managed Medicaid contracts. ~r ~ ~-by ~ever ~- 1lI~IU~ one example OT Group ~ streptococcal infection provides an illustration of ways in which managed care can provide new opportunities to implement and evaluate clinical practice guidelines for controlling infectious diseases.
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From page 27... ...
Development and adoption of clinical practice guidelines will involve changes in the individual and organizational behaviors of physicians, nurses, health care administrators, patients, and individual health care facilities. Health care providers presented with clinical practice guidelines must consider them in light of the financial incentives of the managed care organization, professional incentives and culture, personal and professional beliefs and experiences, and what they consider to be in the best interest of the patient.
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From page 28... ...
Better care management, which has resulted from the spread of managed care nationwide, is expected to reduce the enormous variations in practices and outcomes that have been documented whenever patterns of practice and outcomes have been evaluated. The promise of managed care to the better management of care has not yet been successfully fulfilled.
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From page 29... ...
Major purchasers of health care must recognize improvements occur when clinicians make decisions about patients. Those purchasers are in a good position to require health plans and hospitals to standardize the required guidelines and to reward those who comply with the guidelines.
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From page 30... ...
These are summarized below as Promoting Adoption and Use of Guidelines in Managed Care Organizations and Involving Clinicians in Guideline Development and Implementation. Promoting Adoption and Use of Guidelines in Managed Care Organizations Providing managed care organizations with opportunities to implement and evaluate clinical practice guidelines can control new and reemerging infectious diseases.
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From page 31... ...
When hospitals and plans recognize that clinical practice guidelines will help make clinical care more effective and more cost-effective, they will be more likely to provide resources to help with the development of local guidelines. The Needfor Systemwide, Standardized Guidelines Subscriber turnover and proprietary restrictions on access to managed care data, combined with the adoption of different clinical practice guidelines across managed care organizations, may compromise efforts to implement systemwide, standardized clinical practice guidelines.
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From page 32... ...
Guidelines may be less of a problem in infectious diseases than in other subspecialties, as shown by the success of one health maintenance organization in achieving a 40 percent reduction in neonatal Group B streptococcus infections. Managed care organizations offer a number of advantages for evaluating this kind of initiative, including patient recruitment, systemwide implementation and monitoring, and a computerized database.
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