Pediatric Informatics: Computer Applications in Child Health (Health ...

Chapter 11
Clinical Practice Guidelines: Supporting
Decisions, Optimizing Care
Richard N. Shiffman
Objectives
To distinguish clinical practice guidelines from other quality improvement tools
To outline the production of and barriers to guidelines
To provide an overview of guideline implementation and a pediatric example
11.1 Introduction: Why Guidelines are Important
Clinical practice guidelines (CPGs) are repositories of high quality medical
knowledge. During the past decade and a half, as techniques for distilling clinical
knowledge from basic research have improved, data may be gathered efficiently
and transformed in a timely basis into useful summaries of the best available evidence.
CPGs are the subject of considerable interest in clinical medicine and informatics.
Clinicians look to guidelines for credible assistance in resolving problems
they face in daily practice.
Informaticians view guidelines as a mechanism to overcome the “knowledge
acquisition bottleneck,” i.e., the extraction of knowledge from experts in a format
that can be processed by computers. Other problems in CPG dissemination include
selection of the “best” guideline on a particular topic when “competing” documents
for management of common conditions are developed 1 and the high cost of
CPG development (US guidelines cost on average $100,000–200,000 2 and require
periodic updating).
11.2 What is a Guideline? How Guidelines Differs
from Other Quality Improvement Tools
In 1992, the Institute of Medicine 3 created the most commonly quoted definition
for a guideline: a “systematically developed statement to assist practitioner and
patient decisions about appropriate health care for specific clinical circumstances.”
C.U. Lehmann et al. (eds.), Pediatric Informatics: Computer Applications 149
in Child Health, Health Informatics,
© Springer Science + Business Media, LLC 2009