The status of pediatric practice guidelines.

Abstract

Clinicians caring for children increasingly encounter practice guidelines. Guidelines have emerged as a driving force in American medicine. They are appearing more regularly in academic journals, and are often the basis of audits by health insurers. Pediatricians are no longer shielded from this component of the quality of care revolution. Because of the expanded presence of guidelines in the daily work of clinicians, and the substantial expenditure of time and resources by government, medical societies, hospitals, and insurers in guideline-related activities, we convened a conference to review the status of pediatric practice guidelines. The goal of the conference was to establish a dialogue among key constituencies in the care of children. Participants included primary care providers, researchers, health insurers, representatives of professional societies and governmental agencies, and parents. Specific goals of the conference were to: (1) assess the status of guidelines in pediatric care—what guidelines exist, how are they perceived by clinicians, and how have they affected care; (2) to define the unique challenges for pediatric guidelines; and (3) to discuss research agendas and plan implementation strategies. The conference was divided into five sections: (1) an overview of guidelines; (2) guidelines for preventive care; (3) guidelines addressing the management of children with illness; (4) parental perspectives on guidelines; and (5) practitioner views of guidelines. This commentary represents a summary of the discussions and our opinions about the clinical, research, and policy implications. These opinions, while we hope reflective of the discussion, are those of the authors and not the participants (see Appendix). Analysis of medical practice reveals variation in care not easily accounted for by differences in patient and illness characteristics. For example, Perrin and others,1,2 in a series of investigations, have demonstrated that children with any medical condition are far more likely to be admitted to …