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

150 R.N. Shiffman
Synonyms include practice standards, protocols, practice parameters, algorithms,
care plans, and critical pathways. Each term represents a minor variation which
fulfills the elements of the IOM definition.
Guidelines may also serve as criteria for medical review, performance measures
and reimbursement, although these are generally applied after care has been
provided to assess its quality. In these cases, their use does not fit the criterion of
assisted decision-making that would allow them to meet the definition of practice
guidelines.
11.3 The Guideline Lifecycle
The guideline lifecycle is a series of stages from conception to revision. 4
The lifecycle begins with the perception of a need to standardize processes.
This perception may be based on recognition of variations in care delivery, of
the need to clarify the evidence base supporting a topic or an expectation of cost
savings.
Once the need for a guideline is recognized and resources are assembled,
authoring begins. Authoring is translation of published evidence and expert
consensus into formal policy statements. Ideally, a multidisciplinary group of
stakeholders and experts define a set of questions that the guideline addresses.
Following an exhaustive literature search and a filtering process to select wellperformed
and relevant studies that address the clinical questions, guideline
authors develop a draft document that defines appropriate diagnosis and management,
based on synthesis of evidence and weighing of anticipated benefits,
risks, harms, and costs. Several drafts are prepared and critiqued until consensus
is reached. The penultimate draft is then circulated to nonparticipant stakeholders
for critical review and revision if necessary and finally sanctioned by the
sponsoring organization.
In dissemination, the guideline is circulated to its intended audience in a nontargeted
manner. Guidelines are published in professional journals, sent directly
to stakeholders who may be interested in the topic and/or made available online
via sponsoring organizations. The Agency for Healthcare Research and Quality
maintains the National Guidelines Clearinghouse on a website (www.guidelines.
gov) that archives and indexes almost 2,000 practice guidelines.
Guideline implementation is the assimilation of recommendations into clinical
care processes, through operationalization in specific clinical settings to
improve local outcomes of care. Guideline implementation into information
systems requires encoding to make them computer-executable.
Guideline maintenance by representatives of the authoring organization focuses
on revision of recommendations based on changes in the evidence base. Most
organizations specify a time period after which each guideline must be reviewed,
revised if necessary or retired.