Overview Of Clinical Practice Guidelines Research Articles

Optimizing Medical Care Via Practice Guidelines and Quality Improvement Initiatives

In an effort, to curtail rising health care costs, government and private payers have begun to focus on measuring quality of care. Along with quality improvement initiatives, clinical practice guidelines may also be utilized to provide better care. Clinical practice guidelines are recommendations for clinicians about the care of patients with specific conditions. This review provides an overview of clinical practice guidelines and quality improvement initiatives to highlight strategies to optimize patient outcomes.

Improving access to clinical practice guidelines with an interactive graphical interface using an iconic language.

BackgroundClinical practice guidelines are useful for physicians, and guidelines are available on the Internet from various websites such as Vidal Recos. However, these guidelines are long and difficult to read, especially during consultation. Similar difficulties have been encountered with drug summaries of product characteristics. In a previous work, we have proposed an iconic language (called VCM, for Visualization of Concepts in Medicine) for representing patient conditions, treatments and laboratory tests, and we have used these icons to design a user interface that graphically indexes summaries of product characteristics. In the current study, our objective was to design and evaluate an iconic user interface for the consultation of clinical practice guidelines by physicians.MethodsFocus groups of physicians were set up to identify the difficulties encountered when reading guidelines. Icons were integrated into Vidal Recos, taking human factors into account. The resulting interface includes a graphical summary and an iconic indexation of the guideline. The new interface was evaluated. We compared the response times and the number of errors recorded when physicians answered questions about two clinical scenarios using the interactive iconic interface or a textual interface. Users’ perceived usability was evaluated with the System Usability Scale.ResultsThe main difficulties encountered by physicians when reading guidelines were obtaining an overview and finding recommendations for patients corresponding to “particular cases”. We designed a graphical interface for guideline consultation, using icons to identify particular cases and providing a graphical summary of the icons organized by anatomy and etiology. The evaluation showed that physicians gave clinical responses more rapidly with the iconic interface than the textual interface (25.2 seconds versus 45.6, p < 0.05). The physicians appreciated the new interface, and the System Usability Scale score value was 75 (between good and excellent).ConclusionAn interactive iconic interface can provide physicians with an overview of clinical practice guidelines, and can decrease the time required to access the content of such guidelines.

The challenges of lower urinary tract symptoms in men.

Two distinct urologic entities were discussed in depth at the 2nd Annual Canadian Urology Forum (2012): stress urinary incontinence (SUI) in women; and lower urinary tract symptoms (LUTS) in men. The LUTS component of the educational program included a distinguished panel of Canadian and international experts, who collaborated to present and discuss the most up-to-date, evidence-based medicine and to share their own clinical experiences. The overall learning objectives of this session were to: Recognize and describe what constitutes LUTS in older male patients; Define the roles of the prostate, bladder and other organs associated with LUTS; Identify the major knowledge gaps in the management of male patients who are experiencing LUTS; and Assess the evidence for currently available medical and interventional options to treat LUTS. The faculty members presented six individual topics during the LUTS educational sessions. Dr. Claus Roehrborn, Professor and Chair in the Department of Urology at the University of Texas Southwestern Medical Center at Dallas, Texas, provided an overview of clinical practice guidelines for LUTS and benign prostatic hyperplasia (BPH). Dr. J. Curtis Nickel, Professor in the Department of Urology at Queen’s University in Kingston, Ontario, and Tier 1 Canadian Institutes of Health Research Canada Research Chair in Urologic Pain and Inflammation, led a thought-provoking session on LUTS associated with prostatitis. Prof. Marcus Drake, Senior Lecturer in Urology at the University of Bristol, Bristol, United Kingdom, presided over two separate presentations. The first was an examination of male LUTS associated with overactive bladder, while the second was a discussion of “The Dilemma of Nocturia.” Dr. Victor Nitti, Professor of Urology and Obstetrics and Gynecology and the Vice Chairman of the Department of Urology at New York University (NYU) Langone Medical Center, provided an overview of the appropriate workup of a man presenting with LUTS. Finally, Dr. Mostafa Elhilali presented a comprehensive overview of the various surgical treatment options for benign prostatic hyperplasia. Summaries of each of these presentations are provided in the following pages of this supplement. At the conclusion of the above-mentioned lectures and associated discussion sessions, the faculty and participants again interacted through the discussion a complex case study detailing the appropriate management of a male patient with LUTS. The highlights of this discussion are also captured in the following pages. The steering committee for the Canadian Urology Forum 2012 hopes that this document provides valuable information on LUTS in men to Canadian health-care professionals and their peers around the world.

The challenges of lower urinary tract symptoms in men

Two distinct urologic entities were discussed in depth at the 2nd Annual Canadian Urology Forum (2012): stress urinary incontinence (SUI) in women; and lower urinary tract symptoms (LUTS) in men. The LUTS component of the educational program included a distinguished panel of Canadian and international experts, who collaborated to present and discuss the most up-to-date, evidence-based medicine and to share their own clinical experiences. The overall learning objectives of this session were to: Recognize and describe what constitutes LUTS in older male patients; Define the roles of the prostate, bladder and other organs associated with LUTS; Identify the major knowledge gaps in the management of male patients who are experiencing LUTS; and Assess the evidence for currently available medical and interventional options to treat LUTS. The faculty members presented six individual topics during the LUTS educational sessions. Dr. Claus Roehrborn, Professor and Chair in the Department of Urology at the University of Texas Southwestern Medical Center at Dallas, Texas, provided an overview of clinical practice guidelines for LUTS and benign prostatic hyperplasia (BPH). Dr. J. Curtis Nickel, Professor in the Department of Urology at Queen’s University in Kingston, Ontario, and Tier 1 Canadian Institutes of Health Research Canada Research Chair in Urologic Pain and Inflammation, led a thought-provoking session on LUTS associated with prostatitis. Prof. Marcus Drake, Senior Lecturer in Urology at the University of Bristol, Bristol, United Kingdom, presided over two separate presentations. The first was an examination of male LUTS associated with overactive bladder, while the second was a discussion of “The Dilemma of Nocturia.” Dr. Victor Nitti, Professor of Urology and Obstetrics and Gynecology and the Vice Chairman of the Department of Urology at New York University (NYU) Langone Medical Center, provided an overview of the appropriate workup of a man presenting with LUTS. Finally, Dr. Mostafa Elhilali presented a comprehensive overview of the various surgical treatment options for benign prostatic hyperplasia. Summaries of each of these presentations are provided in the following pages of this supplement. At the conclusion of the above-mentioned lectures and associated discussion sessions, the faculty and participants again interacted through the discussion a complex case study detailing the appropriate management of a male patient with LUTS. The highlights of this discussion are also captured in the following pages. The steering committee for the Canadian Urology Forum 2012 hopes that this document provides valuable information on LUTS in men to Canadian health-care professionals and their peers around the world.

Clinical practice guidelines to inform evidence-based clinical practice

With the volume of medical research currently published, any one practitioner cannot independently review the literature to determine best evidence-based medical care. Additionally, non-specialists usually do not have the experience to know best practice for all of the frequent clinical circumstances for which there is no good evidence. Clinical practice guidelines (CPGs) help clinicians to address these problems because they are systematically created documents that summarize knowledge and provide guidance to assist in delivering high-quality medicine. They aim to improve health care by identifying evidence that supports the best clinical care and making clear which practices appear to be ineffective. Non-structured literature review. CPGs combine evidence-based medicine (on topics for which evidence exists) with expert opinion (on topics for which there is no evidence). The optimal CPG applies structured and transparent judgments, from an unbiased and diverse panel which includes both clinical experts and non-physicians, to a systematic evidence review. It includes decisions in areas in which clinical data are both available and unavailable. The resulting guideline statements should be clearly linked to the quality of the available evidence and the target patient(s) should be clearly defined, so that the reader can assess strength and applicability of the statements to an individual patient. The application of high-quality CPGs improves patient care, but all too often CPGs are not used to the greatest advantage because of inadequate dissemination and incorporation into practice. This article provides an overview of CPGs, focusing on their justification, creation, improvement, and use.

Why all prostate cancer surgery should include an adequate lymph node dissection

The role of a lymph node dissection in most cancer sites portends a benefit from accurate staging and assignment of adjuvant therapy or, possibly, a direct therapeutic effect by local/regional control. The adequacy of this regional dissection has become an important quality of care indicator (i.e., colon, rectal, testes and bladder). The adoption of recommendations to limit lymphadenectomy in other sites has generally followed prospective studies (i.e., uterine) or established predictive tools (i.e., sentinel biopsy in melanoma, breast cancer). This issue is controversial for prostate cancer management given the lack of prospective data and ambiguous retrospective studies1 and is illustrated in the variation in our clinical practice guidelines (Table 1).2–5 Table 1. Overview of clinical practice guidelines on prostate cancer management Coincident with the decrease of lymph node involvement (LNI) in most prostatectomy series6,7 there has been remarkable decline in pelvic lymph node dissection (PLND) for low-risk disease,8 although this trend may be less apparent in Canada.9 A risk-adapted approach to PLND remains controversial; it has been suggested that other complicating elements are involved in its decline, including changes in surgical approach as well as reimbursement issues.10 But what is the evidence to abandon this concept of regional control for prostate cancer in patients with perceived low-risk disease? Without prospective randomized data the argument to omit PLND generally revolves around the following three issues: staging, therapeutic benefit and side effects.

The EDUCATE Study: A Continuing Education Exemplar for Clinical Practice Guideline Implementation

Cancer care is evolving from a solo practitioner care delivery system based on tradition and anecdotal experience to a multidisciplinary, collaborative, science-driven paradigm. Evidence-based practice facilitates optimal care quality for patients with cancer and is effected for medical and nursing practitioners through clinical practice guideline implementation. Clinician education based on principles of adult learning is one method of implementing clinical practice guidelines in clinical practice. However, research demonstrates that conventional static methods of education do little to change behavior; instead, effective education incorporates interactive formats, provides feedback, and includes reminder and reinforcement strategies. The EDUCATE (Educating Clinicians to Achieve Treatment Guideline Effectiveness) Study offers one model for clinical practice guideline implementation using educational methods. A faculty of nurse educators, together with practice champions, carried out an intensive educational intervention comprised of multiple teaching/learning activities during a 12-month period in community oncology practices throughout the United States. In addition to an overview of clinical practice guidelines and educational methods that can be used for implementation of clinical practice guidelines, the obstacles faced and lessons learned through the EDUCATE Study are presented, along with recommendations for implementation in the practice setting.

Clinical practice guidelines and their role in quality of care assessments

Clinical practice guidelines may be defined as systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical conditions. The practice guideline is a management plan that enables healthcare providers to make sequential decisions about testing or therapy in a given clinical situation. Given the heterogeneity of disease presentations and the complexity of making therapeutic decisions, the development of guidelines in neurosurgery presents unique problems and challenges. Clinical practice guidelines were developed in part as a method for the assessment of quality of medical care processes. Practice guidelines serve as a tool for comparisons to be made within and between healthcare delivery systems. The implementation of guidelines also allows for the acquisition of clinical and financial data that provide for outcomes analysis and other types of information. The characterization of patterns of care in different institutions and the relationship between patterns of care and outcomes will in the future allow for quality improvement, enable physicians to offer predictability and accountability to third-party interests, and contribute to an understanding of how to offer the best care to neurosurgical patients. The author provides an overview of clinical practice guidelines and illustrates their role in the assessment of quality of patient care, demonstrates how they fit into the methodology of quality assessments, and underscores the importances of practice quidelines for the development of disease management systems.