How to structure clinical practice guidelines for continuous quality improvement?

E Andrew Balas, Jerome Puryear, Joyce A. Mitchell, Bruce Barter

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The purpose of this study was to evaluate the relevance of available practice guidelines to clinical quality improvement programs. A sample of 19 guidelines was evaluated in four prominent primary care areas. Two research assistants independently coded the clinical conditions and recommended/not recommended procedures abstracted from the guidelines (Cohen's kappa .67 and .50, respectively). An average of 35.1 (±25.8) medical conditions and 48.4 (±41.5) clinical procedures were defined by the guidelines. Most conditions were defined by using ICD-9-CM, age/sex group, or therapy, but 29% of definitions included symptoms which are not coded routinely. CPT codes alone were unable to identify most procedures. AHCPR guidelines mentioned significantly more procedures (p < .001) and fewer symptoms (p < .001) per clinical condition than other guidelines. The difficulty of finding codes for conditions and procedures, the high rate of non-codable items, and the lack of recommended measures limit the applicability of published clinical practice guidelines to continuous quality improvement programs.

Original languageEnglish (US)
Pages (from-to)289-297
Number of pages9
JournalJournal of Medical Systems
Volume18
Issue number5
DOIs
StatePublished - Oct 1 1994

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Quality Improvement
Practice Guidelines
Guidelines
Current Procedural Terminology
International Classification of Diseases
Group Psychotherapy
Primary Health Care
Age Groups
Research

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Information Systems
  • Health Informatics
  • Health Information Management

Cite this

How to structure clinical practice guidelines for continuous quality improvement? / Balas, E Andrew; Puryear, Jerome; Mitchell, Joyce A.; Barter, Bruce.

In: Journal of Medical Systems, Vol. 18, No. 5, 01.10.1994, p. 289-297.

Research output: Contribution to journalArticle

Balas, E Andrew ; Puryear, Jerome ; Mitchell, Joyce A. ; Barter, Bruce. / How to structure clinical practice guidelines for continuous quality improvement?. In: Journal of Medical Systems. 1994 ; Vol. 18, No. 5. pp. 289-297.
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