The implementation of clinical guidelines in a managed care setting: implications for children with special health care needs.
BACKGROUND
The project tracked the development and implementation of a pediatric asthma guideline to determine its usefulness as a quality assurance mechanism for children with special health care needs.


METHODS
Interviews were conducted with clinic staff to gather descriptive information about guideline implementation at owned clinics within a large HMO.


RESULTS
Providers developed multiple implementation strategies emphasizing patient/family education. Service coordination within the health plan was well established, while coordination of services beyond the health plan was less clearly related to guideline implementation.


CONCLUSIONS
Guideline implementation appeared to be a highly variable process. Clinical guidelines alone may not be sufficient tools of quality assurance for children with chronic or complex conditions.
Rolnick
S J
SJ
HealthPartners Research Foundation, Minneapolis, Minnesota, USA.
Flores
S K
SK
O'Fallon
A M
AM
Vanderburg
N R
NR
D000293:Adolescent; D000465:Algorithms; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000592:standards; D002908:Chronic Disease; D003266:Continuity of Patient Care / Q000458:organization & administration; D019988:Children with Disabilities; D006279:Health Maintenance Organizations / Q000592:standards*; D006801:Humans; D008910:Minnesota; D019982:Organizational Case Studies; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation