Guideline (medical)

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A medical guideline (also called a clinical guideline, clinical protocol or clinical practice guideline) is a document with the aim of guiding decisions and criteria in specific areas of healthcare, as defined by an authoritative examination of current evidence (evidence-based medicine). Guidelines usually include summarized consensus statements, but unlike the latter, they also address practical issues.

Clinical guidelines briefly identify, summarize and evaluate the best evidence and most current data about prevention, diagnosis, prognosis, therapy, risk/benefit and cost-effectiveness. Then they define the most important questions related to clinical practice and identify all possible decision options and their outcomes. Thus, they integrate the identified decision points and respective courses of action to the clinical judgment and experience of practitioners. Many guidelines place the treatment alternatives into classes to help providers in deciding which treatment to use.

Additional objectives of clinical guidelines are to standardize medical care, to raise quality of care, to reduce several kinds of risk (to the patient, to the healthcare provider, to medical insurers and health plans) and to achieve the best balance between cost and medical parameters such as effectiveness, specificity, sensitivity, resolutiveness, etc.

The guideline-based approach to healthcare is a relatively recent one and has originated in the United States in the 90s. Guidelines are usually produced at national or international levels by medical associations or governmental bodies, such as the US Agency for Healthcare Research and Quality. Local healthcare providers may produce their own set of guidelines or adapt them from existing top-level guidelines. It has been demonstrated repeatedly that the use of guidelines by healthcare providers such as hospitals is an effective way of achieving the objectives listed above, although they are not the only ones.

Special computer software packages have been developed to facilitate the production and use of medical guidelines. (guideline execution engine). Healthcare workflow is concerned with coordinating task done by different personnel. On-line medical literature databases (such as PubMed) and evidence-based medicine databases (such as the Cochrane Collaboration), and printed and electronic publications exist in large numbers for this purpose. The USA and other countries maintain medical guideline clearinghouses. Clinical guidelines may include or not decision or calculation algorithms.

It has been found^[1] that some simple clinical practice guidelines are not routinely followed to the extent they might be. It has been found that providing a nurse or other medical assistant with a checklist of recommended procedures can result in the attending physician being reminded in a timely manner regarding procedures that might have been overlooked.

In the USA, the National Guideline Clearinghouse maintains a catalog of high quality guidelines published by various organizations (mostly professional physician organizations). In the United Kingdom, clinical practice guidelines are published primarily by the National Institute for Health and Clinical Excellence (NICE). In The Netherlands, two bodies (CBO and NHG) publish specialist and primary care guidelines, respectively. In Germany, the Agency for Quality in Medicine (AEZQ) coordinates a national program for disease management guidelines.
All these organisations are now members of the Guidelines International Network, an international not-for-profit association of organisations and individuals involved in clinical practice guidelines. G-I-N is owner of the International Guideline Library - the largest web based data base of medical guidelines worldwide.

[edit] See also

Treatment Guidelines from The Medical Letter
Medical decision making
Evidence-based medicine
Consensus (medical)
Algorithm (medical)
Clinical protocol (cf. first line of the present article)

[edit] Reference

^ Gina Kolata Program Coaxes Hospitals to See Treatments Under Their Noses. New York Times December 25, 2004. Article (site requires registration and payment of a fee).