title: How to structure clinical practice guidelines for continuous quality improvement?
abstract: The purpose of this study was to evaluate the relevance of available practice guidelines to clinical quality improvement programs. A sample of 19 guidelines was evaluated in four prominent primary care areas. Two research assistants independently coded the clinical conditions and recommended/not recommended procedures abstracted from the guidelines (Cohen's kappa .67 and .50, respectively). An average of 35.1 (+/- 25.8) medical conditions and 48.4 (+/- 41.5) clinical procedures were defined by the guidelines. Most conditions were defined by using ICD-9-CM, age/sex group, or therapy, but 29% of definitions included symptoms which are not coded routinely. CPT codes alone were unable to identify most procedures. AHCPR guidelines mentioned significantly more procedures (p < .001) and fewer symptoms (p < .001) per clinical condition than other guidelines. The difficulty of finding codes for conditions and procedures, the high rate of non-codable items, and the lack of recommended measures limit the applicability of published clinical practice guidelines to continuous quality improvement programs.
authors.affiliation: Health Services Management Program, School of Medicine, University of Missouri-Columbia.
authors.forename: E A
authors.initials: EA
authors.lastname: Balas
authors.forename: J
authors.initials: J
authors.lastname: Puryear
authors.forename: J A
authors.initials: JA
authors.lastname: Mitchell
authors.forename: B
authors.initials: B
authors.lastname: Barter
mesh_terms: D000367:Age Factors; D003933:Diagnosis; D005240:Feasibility Studies; D005260:Female; D005568:Forms and Records Control; D006291:Health Policy; D006801:Humans; D008297:Male; D008499:Medical Records; D015201:Meta-Analysis as Topic; D015233:Models, Statistical; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012737:Sex Factors; D013812:Therapeutics; D017749:Total Quality Management; D014481:United States; D016270:United States Agency for Healthcare Research and Quality