Effectiveness Of Clinical Practice Guidelines Research Articles

Pediatric Residency Training amid the COVID-19 Pandemic: Exploring the Impact of Supervision and Clinical Practice Guidelines on Clinical and Financial Outcomes.

Objective This study is aimed at calculating the magnitude of the effect of clinical practice guidelines (CPG) and supervision in inhibiting the negative impact of the COVID-19 pandemic on clinical and financial outcomes of non-COVID-19 inpatient care by pediatric residents in academic medical center (AMC) hospitals during the COVID-19 pandemic. Methods The cohort retrospective study was conducted. This study collected patient data from pediatric residency programs. A research cohort consisted of non-COVID-19 pediatric patients at Dr. Soetomo General Academic Hospital. This study compared the subgroup of patients treated during the pandemic with those treated before the pandemic. The results were analyzed using SPSS 26.0 and Smart-PLS. Results There was a 41.4% decrease in pediatric inpatients during the pandemic with an increased severity level and complexity level, a reduction of 7.46% availability of supervisors, an increase of 0.4% in readmission < 30 days, an increase of 0.31% in-hospital mortality, an increase the total costs of care, and a decrease of insurance claim profit. CPG did not moderate the effect of the COVID-19 pandemic on the clinical outcomes (β = −0.006, P = 0.083) but moderated the financial outcomes (β = −0.022, P = 0.000), by reducing the total cost of care and increasing insurance claim profit. Supervision moderated the effect of the COVID-19 pandemic on the clinical outcomes (β = 0.040, P = 0.000) by increasing aLOS and on the financial outcomes (β = −0.031, P = 0.000) by reducing the total cost of care and increasing insurance claim profit. This study model had a 24.0% variance of explanatory power for clinical outcomes and 49.0% for financial outcomes. This study's structural model effectively predicted clinical outcomes (Q2 = 0.238) and financial outcomes (Q2 = 0.413). Conclusion Direct supervision inhibited the negative impact of the COVID-19 pandemic on both clinical and financial outcomes of non-COVID-19 inpatient care by pediatric residents, while CPG only inhibited the negative impact on financial outcomes. Implication of This Study. In a disaster, the availability of CPG and direct supervision makes AMC hospitals able to inhibit the negative impact of disasters on clinical and financial outcomes.

Effectiveness of clinical practice guidelines for acute management of traumatic brain injury at a regional referral hospital in Tanzania

Effectiveness of clinical practice guidelines for acute management of traumatic brain injury at a regional referral hospital in Tanzania

Ketamine Use in Operation Enduring Freedom.

Ketamine is a dissociative anesthetic increasingly used in the prehospital and battlefield environment. As an analgesic, it has been shown to have comparable effects to opioids. In 2012, the Defense Health Board advised the Joint Trauma System to update the Tactical Combat Casualty Care Guidelines to include ketamine as an acceptable first line agent for pain control on the battlefield. The goal of this study was to investigate trends in the use of ketamine during Operation Enduring Freedom (OEF) and Operation Freedom's Sentinel (OFS) during the years 2011-2016. A retrospective review of Department of Defense Trauma Registry (DoDTR) data was performed for all patients receiving ketamine during OEF/OFS in 2011-2016. Prevalence of ketamine use, absolute use, mechanism of injury, demographics, injury severity score, provider type, and co-administration rates of various medications and blood products were evaluated. Total number of administrations during the study period was 866. Ketamine administration during OEF/OFS increased during the years 2011-2013 (28 patient administrations in 2011, 264 administrations in 2012, and 389 administrations in 2013). A decline in absolute use was noted from 2014 to 2016 (98 administrations in 2014, 41 administrations in 2015, and 46 administrations in 2016). The frequency of battlefield ketamine use increased from 0.4% to 11.3% for combat injuries sustained in OEF/OFS from 2011 to 2016. Explosives (51%) and penetrating trauma (39%) were the most common pattern of injury in which ketamine was administered. Ketamine was co-administered with fentanyl (34.4%), morphine (26.2%), midazolam (23.1%), tranexamic acid (12.3%), plasma (10.3%), and packed red blood cells (18.5%). This study demonstrates increasing use of ketamine by the U.S. Military on the battlefield and effectiveness of clinical practice guidelines in influencing practice patterns.

Evaluation of implementation effect of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for acute tonsillitis

The purpose of this article is to evaluate the clinical effect of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for acute tonsillitis. The applicability and application of the Guideline were evaluated based on the clinicians by using the electronic questionnaire. Questionnaires about 538 on application evaluation and 502 questionnaires on applicability evaluation were completed from April 28 to July 9, 2018. The subjects in the questionnaires include the clinicians with junior title, intermediate title, and senior title that have used this Guideline. The descriptive statistical analysis of the collected questionnaire was carried out. In the applicability evaluation, according to the classification of professional titles, the application rate was highest in intermediate title clinicians (26.77%), followed by junior (23.98%) and deputy senior (19.33%) professional title clinicians. In the quality evaluation, the rationality of application scope (98.61%) and the terminology accuracy (98.81%) scores were higher, and the rationality of differentiation and classification (96.05%) was the lowest. The applicability evaluation suggested that clinicians believed this Guideline had high safety (98.42%), reasonable content (98.03%), significant effect (99.6%), reduced use of antibiotics in Western medicine (93.89%), and a high applicability ratio (96.44%). In the application evaluation, Department of lung disease showed the highest application rate (44.24%); rationality of the Guideline was more than 97% in treatment rules and prophylaxis except the syndrome differentiation (92.75%); a high ratio of clinicians believed the recommended scheme was good: curative effect 97.4%, safety 97.59%, and economy 93.87%. The study shows that the clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for acute tonsillitis is of good quality, high clinical use and good effect. It can be used as a standardized treatment scheme for acute tonsillitis in traditional Chinese medicine. But there are some unsuitable contents and need to be further improved. The Guideline should strengthen the revision on differentiation of symptoms and signs as well as prophylaxis.

Substantial reduction in hospital stay of children and adolescents with diabetic ketoacidosis after implementation of Clinical Practice Guidelines in a university hospital in Saudi Arabia.

We aimed to determine the effect of Clinical Practice Guideline (CPG) implementation on length of hospital stay of children and adolescents with diabetic ketoacidosis (DKA). This was a 6-year (2008-2014) case-control retrospective study conducted at King Khalid University Hospital, Riyadh, that compared patients with DKA managed using CPG with those treated before CPG implementation. There were 63 episodes of DKA in 41 patients managed using CPG compared with 40 episodes in 33 patients treated before implementation of CPG. Baseline characteristics of the 2 groups were similar (age, sex, newly diagnosed patients, recurrent DKA, DKA severity, and mean glycosylated hemoglobin). The mean length of hospital stay (±SD) was 68.6±53.1hours after implementation of CPG compared with 107.4±65.6hours before implementation (P<.001). The reduction in length of hospital stay equals to 1700 bed days saved per year per 1000 patients. Implementation of CPG for DKA decreased the length of hospital stay.

Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Diagnosis and Treatment of Chronic Cough in the Adult

Successful management of chronic cough has varied in the primary research studies in the reported literature. One of the potential reasons relates to a lack of intervention fidelity to the core elements of the diagnostic and/or therapeutic interventions that were meant to be used by the investigators. We conducted a systematic review to summarize the evidence supporting intervention fidelity as an important methodologic consideration in assessing the effectiveness of clinical practice guidelines used for the diagnosis and management of chronic cough. We developed and used a tool to assess for five areas of intervention fidelity. Medline (PubMed), Scopus, and the Cochrane Database of Systematic Reviews were searched from January 1998 to May 2014. Guideline recommendations and suggestions for those conducting research using guidelines or protocols to diagnose and manage chronic cough in the adult were developed and voted upon using CHEST Organization methodology. A total of 23 studies (17 uncontrolled prospective observational, two randomized controlled, and four retrospective observational) met our inclusion criteria. These articles included 3,636 patients. Data could not be pooled for meta-analysis because of heterogeneity. Findings related to the five areas of intervention fidelity included three areas primarily related to the provider and two primarily related to the patients. In the area of study design, 11 of 23 studies appeared to be underpinned by a single guideline/protocol; for training of providers, two of 23 studies reported training, and zero of 23 reported the use of an intervention manual; and for the area of delivery of treatment, when assessing the treatment of gastroesophageal reflux disease, three of 23 studies appeared consistent with the most recent guideline/protocol referenced by the authors. For receipt of treatment, zero of 23 studies mentioned measuring concordance of patient-interventionist understanding of the treatment recommended, and zero of 23 mentioned measuring enactment of treatment, with three of 23 measuring side effects and two of 23 measuring adherence. The overall average intervention fidelity score for all 23 studies was poor (20.74 out of 48). Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines.

Appraisal of Five Clinical Guidelines for the Management of Hypertension in Andean Countries and Europe

There is global concern on the methodological limitations, transferability and effectiveness of clinical practice guidelines (CPGs) for chronic non-communicable diseases, particularly for hypertension. Bolivia, Ecuador and Peru have regularly produced CPGs; however no formal assessment has been done on their contents, transferability and effectiveness. The past decade saw significant migration from Andean countries to Europe. Knowing how European CPGs compare with those produced in Andean countries is necessary to recommend future changes targeted to the migrant population. A systematic search of CPGs was done on indexed databases and non-indexed publications. Recognized and approved CPGs were identified by technical officers in the Ministries of Health of the respective countries. The guidelines of the European Society of hypertension and four selected CPGs from the Andean countries were assessed by two independent evaluators using the “Agree II instrument for assessing clinical practice guidelines, AGREE II Consortium, May 2009”. Comparison of the CPGs is based on the six domain scores provided by the Agree II instrument. The overall score of CPGs ranged from 1.85 to 2.94 of 6 maximum possible. The European CPG scored highest in 3 of 6 domains compared, most notably in rigor of development. Average domain scores for clarity of presentation (0.84) and scope and purpose (0.64) were highest scores for applicability (0.30). Stakeholder involvement (0.28) and rigor of development (0.17) were the lowest. The CPGs assessed appear to fail meeting the standards of quality and pertinence. They show a progressive worsening from domains declaring good intentions of being clear, to those which measure their hard aspects and implications.

Evidence-based clinical practice guidelines vs. family physician usual care for the treatment of acute lower back pain: what is the role of chiropractic?

Bishop PB, Quon JA, Fisher CG, Dvorak MFS. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. Spine J 2010; 10: 1055–64.

Lipid-lowering drugs in ischaemic heart disease: A quasi-experimental uncontrolled before-and-after study of the effectiveness of clinical practice guidelines

BackgroundCardiovascular diseases(CVD), specifically ischaemic heart disease(IHD), are the main causes of death in industrialized countries. Statins are not usually prescribed in the most appropriate way. To ensure the correct prescription of these drugs, it is necessary to develop, disseminate and implement clinical practice guidelines(CPGs), and subsequently evaluate them.The main objective of this study is to evaluate the effectiveness of the implementation of consensual Lipid-lowering drugs (LLD) prescription guidelines in hospital and primary care settings, to improve the control of Low-Density Lipoprotein Cholesterol (LDL-C) levels in patients with IHD in the Terres de l'Ebre region covered by the Catalonian Health Institute. Secondary objectives are to assess the improvement of the prescription profile of these LLDs, to assess cardiovascular morbimortality and the professional profile and participant centre characteristics that govern the control of LDL-C.Methods/DesignDesign: Quasi-experimental uncontrolled before and after study. The intervention consists of the delivery of training strategies for guideline implementation (classroom clinical sessions and on-line courses) aimed at primary care and hospital physicians. The improvement in the control of LDL-C levels in the 3,402 patients with IHD in our territory is then assessed.Scope: Primary care physicians from 11 basic health areas(BHAs) and two hospital services (internal medicine and cardiology).Sample: 3,402 patients registered with IHD in the database of the Catalan Institute of Health(E-cap) before December 2008 and patients newly diagnosed during 2009-2010.Variables: Percentage of patients achieving good control of LDL-C, measured in milligrams per decilitre. The aim of the intervention is to achieve levels of LDL-C < 100 mg/dl in patients with IHD. Secondary variables measure type and time of diagnosis of IHD, type and dose of prescribed cholesterol-lowering drugs, level of physician participation in training activities and their professional profile.DiscussionThe development of prescription guidelines previously agreed by various medical specialists involved in treating IHD patients have usually improved drug prescription. The guideline presented in this study aims to improve the control of LDL-C by training physicians through presential and on-line courses on the dissemination of this guideline, and by providing feedback on their personal results a year after this training intervention.

The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain

Background context Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear. Purpose To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician–directed usual care (UC) in the treatment of AM-LBP. Study design/setting A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic. Patient sample Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks’ duration. Exclusion criteria included “red flag” conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT). Outcome measures Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks. Methods Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician–directed UC, the components of which were recorded. Results Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27). Conclusions This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician–directed UC in the treatment of patients with AM-LBP. Compared to family physician–directed UC, full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.

The Chiropractic Hospital-Based Interventions Research Outcomes (CHIRO) Study: A Randomized Controlled Trial on the Effectiveness of Clinical Practice Guidelines in the Medical and Chiropractic Management of Patients with Acute Mechanical Lower Back Pain

The Chiropractic Hospital-Based Interventions Research Outcomes (CHIRO) Study: A Randomized Controlled Trial on the Effectiveness of Clinical Practice Guidelines in the Medical and Chiropractic Management of Patients with Acute Mechanical Lower Back Pain

Opinions on the Content and Effects of Clinical Practice Guidelines for CKD: A Survey of Nephrologists in Australia and New Zealand

Evidence-based clinical practice guidelines have been a major development in nephrology internationally, but it is uncertain how the nephrology community regards these guidelines. This study aimed to determine the views of nephrologists on the content and effects of their local guidelines (Caring for Australasians with Renal Impairment [CARI]). In 2006, a self-administered survey was distributed to all Australian and New Zealand nephrologists. Seven questions were repeated from a similar survey in 2002. A total of 211 nephrologists (70% of practicing nephrologists) responded. More than 90% agreed that the CARI guidelines were a useful summary of evidence, and nearly 60% reported that the guidelines had significantly influenced their practice. The proportion of nephrologists reporting that the guidelines had improved patient outcomes increased from 14% in 2002 to 38% in 2006. The proportion of nephrologists indicating that the guidelines did not match the best available evidence decreased from 30% in 2002 to 8% in 2006. Older age and male sex showed some associations with a less favorable response for some domains. The CARI approach of rigorous evidence-based guidelines has been shown to be a successful model of guideline production. Almost all nephrologists regarded the CARI guidelines as useful evidence summaries, although only one-third believed that the guidelines affected health outcomes. Attitudes to the guidelines have become more favorable over time; this may reflect changes in the CARI process or attitudinal changes to evidence among nephrologists. Evaluation by the end user is fundamental to ensuring the applicability of guidelines in clinical practice in the future.

Clinical practice guidelines and organizational adaptation: A framework for analyzing economic effects

The overall objective of this article was to review the theoretical and conceptual dimensions of how the implementation of clinical practice guidelines (CPGs) is likely to affect treatment costs. An important limitation of the extant literature on the cost effects of CPGs is that the main focus has been on clinical adaptation. We submit that the process innovation aspects of CPGs require changes in both clinical and organizational dimensions. We identify five organizational factors that are likely to affect the relationship between CPGs and total treatment costs: implementation, coordination, learning, human resources, and information. We review the literature supporting each of these factors. The net organizational effects of CPGs on costs depends on whether the cost-reducing properties of coordination, learning, and human resource management offset potential cost increases due to implementation and information management. Studies of the cost effects of clinical practice guidelines should attempt to measure, to the extent possible, the effects of each of these clinical and organizational factors.

Evidence-based assessment of the effectiveness of clinical practice guidelines

The objectives of evidence-based assessment of the effectiveness of clinical practice guidelines are:first, to evaluate the validity, reproducibility, reliability, and applicability of the guidelines prepared;second, to evaluate whether the preventive measures against fractures and osteoporosis taken by the application of the guidelines have become evidence-based, and whether the contents and methods of guidance and education for public health nurses and nutritionists, who perform fracture-control activities, have been improved;and, lastly, to evaluate whether the frequency of fracture has been reduced by the use of the guidelines. Designs for the effectiveness assessment include the randomized controlled trial, non-randomized controlled trial, and before-after trial. It is important to establish the effectiveness of the guidelines by incorporating one of these designs in the preventive measures.

Decreasing Antibiotic Overuse in Neonatal Intensive Care Units: Quality Improvement Research

Overutilization of antibiotics and emergence of resistant bacteria are important problems, particularly in intensive care units. To date, reproducible interventions to improve antibiotic utilization in hospitals have not been proven to be effective or safe. Evidence-based medicine, clinical practice guidelines, and health information technology are frequently promoted as means to cross the “quality chasm” described by the Institute of Medicine. This article outlines how these approaches intersect in a strategy for quality improvement research evaluating the safety and effectiveness of clinical practice guidelines designed to improve antibiotic use in neonatal intensive care units.

Audit of clinical practice guidelines in suicide prevention: who is the auditor?

The term “audit” literally means “official examination of accounts” or “searching examination” (Fowler & Fowler, 1964). In suicidology the concept has traditionally involved clinicians pursuing a clinical and psychosocial “psychological autopsy” in which detailed information about the deceased has been collated. As a result there have been studies from a number of countries which have provided valuable information about the potential for suicide prevention (Cheng, 1995; Conwell et al., 1996). In addition to the more focused psychological autopsy studies, there have been several large surveys including those from Finland (Kerkhof, 1999), England (National Confidential Inquiry, 1999), and Australia (Burgess et al., 2000). These have all documented deficits in the assessment and management of people who have suicided. For example, the Finnish work demonstrated that depression was not adequately assessed or treated (Lonnqvist, 2000), and the English and Australian studies concluded that approximately 20% of suicides of those who had had contact with psychiatric services could have been prevented by the optimum assessment and treatment of depression, more attention to staff-patient relationships and better continuity of care. Such findings have formed the basis for the introduction of evidence-based guidelines for suicide prevention services. However, there are formidable barriers to demonstrating their effectiveness, particularly because of the low base rate of suicide and ethical constraints, which make randomly controlled trials impractical. Therefore, rather than a reduction in suicide being assessed by outcome research, process studies of clinical practice have been undertaken, with the expectation that if guidelines are followed, then more effective management will result and suicide should be less likely. However, it has been demonstrated in some clinical areas that guidelines are often not followed (Cabana et al., 1999). Barriers include lack of familiarity or agreement with guidelines, the inability to overcome previous practice habits, the absence of external monitoring of performance, and the belief that such guidelines downplay the individual clinician’s expertise and experience (Cabana et al., 1999; Davis & Taylor-Vaisey, 1997). It is also sobering that a randomized controlled trial examining the effect of clinical practice guidelines and practice-based education on detection and outcome of depression, the condition most often associated with suicidal behavior, failed to provide improvement in the recognition of, or recovery from, depression (Thompson et al., 2000). This was in contrast to the positive results from nonrandom controlled studies such as that of Rutz et al. (1992) in Gotland. Nevertheless, clinical practice guidelines are a fact of life, and their effectiveness has been demonstrated in other clinical areas, for example in acute myocardial infarction, where there are more inpatient deaths if clinical care is not concordant with recommended guidelines (Scott & Harper, 2002). The question arises of who should audit the implementation and functioning of such clinical guidelines. Traditionally self or peer review has been undertaken, and, more recently, bodies such as the Commission for Health Improvement (2002) in the United Kingdom have been established to ensure improvement in patient care. However, the possibility that excess regulation and auditing could be counter-productive has been raised by Walshe (2002) and Goldberg (2002). Indeed, Walshe (2002) referred to the “regulatory state” (Majone, 1994) or “audit society” (Power, 1997) in commenting on the growth of such scrutiny. An alternative to the establishment of new and specialized auditing authorities would be to involve existing government auditing departments. Traditionally this has occurred when there has been political or public interest in a specific issue, and it could be argued that suicide prevention falls into this category. While not having specific knowledge of suicide prevention, such bodies have wide ranging powers of inquiry and their objective assessment would be beyond question.

A critical approach to clinical practice guidelines.

The rate of publication of clinical practice guidelines for the management of common medical illnesses continues to accelerate. The appropriate dissemination and uptake of high quality practice guidelines can synthesize evidence, improve patient outcomes and enhance the efficiency of health care delivery. However, the methodological rigour and relevance of the growing number of publications labelled 'clinical practice guidelines' vary widely. Health care payers, providers and advocates must learn to appraise and interpret guideline recommendations critically. A simple and practical nine-question approach to evaluating the quality, relevance and effectiveness of clinical practice guidelines is presented.

Familiarity with the Hyperbilirubinemia Guideline Increases Knowledge of Management † 638

Background: The effectiveness of clinical practice guidelines(CPG) as a strategy to change and improve care remains uncertain. Objective: To assess whether familiarity with American Academy of Pediatrics (AAP) CPGs in general, and with the AAP hyperbilirubinemia CPG in particular, is associated with knowledge of the assessment and treatment(including follow-up) of hyperbilirubinemia. Design: Written survey of clinicians at six sites, representing two pediatric emergency departments(ED), two hospital-based practices (HBP), and two office-based private practices (PP). Outcome measure: Percent of questions answered correctly about the assessment (19), treatment and follow-up (7), and overall knowledge (mean of the two subscores) of hyperbilirubinemia. Independent measures: Years since graduation, involvement in quality improvement (QI) activities, attitudes toward CPGs, familiarity with AAP CPGs, familiarity with the AAP hyperbilirubinemia CPG, practice type, provider type(attending, fellow, resident, and nurse practitioner) and experience with newborns. Results: Of 233 eligible clinicians, 186 (79.8%) responded. 42% of clinicians reported familiarity with the AAP hyperbilirubinemia CPG (65% of PP clinicians, 57% of ED clinicians, and 35% of HBP clinicians). Clinicians reporting familiarity with the hyperbilirubinemia CPG achieved higher scores on overall knowledge (p=0.0006) and treatment(p=0.0019). No other independent measure was associated with overall knowledge. After controlling for all other independent measures, familiarity with the AAP hyperbilirubinemia CPG remained associated with overall knowledge(p=0.0066). Assessment score was related to practice (p=0.0001) and provider(p=0.0060) type, while treatment score was related to provider type (p=0.03) as well as familiarity with the AAP hyperbilirubinemia CPG. Conclusions: Reported familiarity with the AAP hyperbilirubinemia CPG is associated with increased knowledge. The findings that knowledge subscores varied by provider and practice type suggest that CPG dissemination and educational approaches should be tailored to particular practice settings. Additional study should also examine whether knowledge relates to actual clinical practice.

Review: Clinical practice guidelines may not improve patient outcomes in primary care

Source Citation Worrall G, Chaulk P, Freake D. The effects of clinical practice guidelines on patient outcomes in primary care: a systematic review. Can Med Assoc J. 1997 Jun 15;156:1705-12.

Using a clinical practice guideline to measure physician practice: translating a guideline for the management of heart failure.

Effective clinical practice guidelines should improve clinical outcomes, and measures of physician use of clinical practice guidelines should correlate with improved outcomes. This study translates a clinical practice guideline on heart failure into review criteria to measure physician performance and the effectiveness of the clinical practice guideline. A panel of 11 family physicians and 1 cardiologist systematically reviewed the clinical practice guideline for its clinical importance, educational relevance, and evaluative appropriateness. Then a subset of 4 family physicians rigorously applied each recommendation to established criteria for measurability and developed an evaluation tool useful in medical record review. The heart failure clinical practice guideline was found to be an excellent educational tool. Using it to measure physician performance, however, was limited to diagnostic tests and drug prescribing. Of 45 recommendations, 5 fulfilled criteria for measurability; 1 recommendation had A-level evidence, whereas 2 recommendations had B-level and 2 had C-level evidence. This study illustrates the logistic issues and challenges in developing a measure of physician adherence to clinical practice guidelines. Medical record review is inadequate to measure many recommendations. Physicians use of this clinical practice guideline must be evaluated as an intermediate step to measuring the effectiveness of clinical practice guidelines based on patient outcomes.