From Paper to Practice to Point of Care: Reports from a Zitter Group Conference on Implementing Practice Guidelines: Getting Physician and Organization Buy-In: A Disease Management Strategy

Abstract

Conference-at-a-Glance This conference, originally titled Implementing Practice Guidelines: A Focus on Changing Physician Behavior and Employing Technology, was held by The Zitter Group in Scottsdale, Arizona, January 21–23, 1996. The Zitter Group is a San Francisco-based health care education and publishing firm that focuses on outcomes research, disease management, pharmacoeconomics, and health care quality improvement. Conference Goals The conference was designed to fulfill the following learning objectives: ■Distinguish between types of guidelines and identify appropriate applications for various settings of care; ■Explain methods for addressing legal liability and risk-exposure issues related to practice guideline development and implementation; ■Describe the role of patient input into guideline development and implementation; ■Identify key success factors and tools for achieving physician buy-in to quality improvement and practice guideline implementation efforts; ■Identify technology applications for implementing practice guidelines; and ■Describe examples and tools for measuring patient outcomes and health care utilization resulting from guideline implementation efforts. Conference Program and Participants The two-day conference of presentations, panels, and workshops and breakout sessions was organized into three segments focusing on (1) securing physician buy-in and other dimensions of guideline development and implementation, (2) using technology to integrate guidelines into electronic systems, and (3) measuring the impact of guidelines on outcomes. A preconference workshop outlined the issues and drew out the various guideline-related needs and experiences of the conference participants, who for the most part were clinicians and who spanned a broad spectrum of experience with guidelines. Eleven presentations with the key resources and references of faculty with direct guideline implementation experience were summarized and adapted for this journal issue. Six presentations survey the implementation issues of engaging physicians through disease management strategy, understanding legal issues, checking implementability of guidelines to improve physician compliance, incorporating patient preferences, creating physician profiling systems to encourage change, and interpreting the Maine experience with the affirmative defense. Three presentations explore approaches to integrating guidelines into existing information systems, developing and testing computerized decision support systems, and using the electronic patient record at the point of care. Two presentations recount processes for measuring the results of specific guidelines in terms of patients' outcomes from the perspectives of a large consulting company and a large community health maintenance organization.