Use of clinical practice guidelines in managed care physician groups
E. Fang, B. S. Mittman and S. Weingarten
Department of Medicine, University of California, Los Angeles School of Medicine, USA.
There is increasing interest in the use of clinical guidelines as a tool to
improve the quality and cost-effectiveness of health care. Yet, relatively
little data are available regarding the use of guidelines by health care
provider organizations. We developed a written descriptive survey
investigating the development, implementation, and evaluation of clinical
guidelines that was administered to medical directors or their designees
from physician medical groups and independent practice associations.
Eighty-seven percent of physician organizations were reported to be
developing or implementing clinical guidelines. The reasons most often
cited for developing clinical guidelines were quality improvement and cost
containment. Local expert opinion or judgment was rated as the most
important influence in the development of clinical guidelines, followed by
medical and scientific literature and externally developed guidelines.
Feedback of information was the most popular method of increasing
compliance with clinical guidelines, although 19% of physician
organizations reported imposing sanctions on physicians who did not use
guidelines. Most of the physician organizations surveyed have embraced
clinical guidelines. Local development or adaptation of clinical guidelines
may be common. There has been disproportionately little attention paid to
guideline implementation and to evaluation of guideline effects relative to
their development.
