Index
A.
Agency for Health Care Policy and Research budget. 56-57, 63
dissemination of guidelines, 190-191
education and dissemination strategies, 88
Forum for Quality and Effectiveness in Health Care, 46, 55, 56, 165 , 212
lessons learned in guidelines development, 165-166
medical review criteria development, 109
Medical Treatment Effectiveness Program, 56-57
Patient Outcomes Research Teams, 56-57, 179
responsibilities for guidelines, 2, 6, 55-57
review of guidelines, 172, 212
topic selection, 175
American Academy of Family Practice, 56
American Academy of Ophthalmology, 48, 169-170
American Academy of Pediatrics, 48, 56, 80, 188
American Board of Family Practice, 87, 101
American Board of Internal Medicine, 87
American Cancer Society, 87, 184
American College of Cardiology, 48-49, 170, 188, 288
American College of Emergency Physicians, 270
American College of Nuclear Physicians, 49
American College of Obstetricians and Gynecologists, 48, 49, 87
American College of Physicians, 184, 188, 275
Center for Applied Research, 52
Clinical Efficacy Assessment Project, 48, 52, 154 n.10, 166-167. 169
American College of Preventive Medicine, 51
American College of Radiology, 48, 49
American College of Surgeons, 264
American Dental Association. 47, 50
American Diabetes Association, 169-170
American Heart Association, 48-49, 170, 288
American Hospital Association, 102
American Medical Association assessment of guidelines, 213
Council on Scientific Affairs, 49
Diagnostic and Therapeutic Technology
Assessment program, 49
''Do Not Resuscitate" guidelines, 28
listings of guidelines, 189
practice guidelines development, 49, 51, 60, 169
Practice Parameters Forum, 49, 60, 169
Specialty Society Partnership, 49, 60, 169
American Medical Center Consortium, 60
American Medical Peer Review Association, 108
American Medical Record Association, 102 n.2
American Medical Review Research Center, 55, 109
American Nurses Association, 47, 50
American Society for Testing and Materials, 92, 311
American Society of Anesthesiology, 48, 49, 51, 74
American Society of Internal Medicine, 172
Anesthesiology guidelines, 48, 49, 51, 74, 125, 130, 131
Appropriateness of care, 5, 27
cost-effectiveness considerations, 143-144
distinguished from practice guidelines, 60
instruments for determining, 57
as practice policies, 33
precertification of services, 41
purpose of, 60
RAND Corporation criteria, 36, 60
research findings on, 37
Assessment instrument, 19, 173, 209-210
attributes of practice guidelines, 350, 364-404
background, 362-364
clarity, 394-397
clinical applicability, 365-367
clinical flexibility, 368-371
development process, 348-350
ideal, 355-356
multi-disciplinary process, 400-404
pretesting and experience with, 359
purposes of, 347-348
question and response categories, 351-353
reliability/reproducibility, 372-374
response aggregation and display, 354
response scoring, 353-354
scheduled review, 398-399
summary evaluation sheet, 405-410
supporting material for guidelines, 357-358
users, 356
validity, 375-393
Assessment of practice guidelines, 199
AMA attributes for, 49
benefits of, 208-209
computer applications in, 90
cost considerations in, 62
credibility, 215
draft reviewers, 171-173, 193-194, 213
feasibility of, 211-215
IMCARE Guidelines Network, 172-173
and legal weight of guidelines, 133
organization for, 19-20, 210-215
peer review, 172
program components, 18
surveys, 192
training in, 86
Attributes of practice guidelines, 7, 8, 28-30
medical review criteria, 7, 8, 9, 111-112
B
Benefit coverage basic benefits, 13, 154, 156
decision making aid, 169
disclosure requirements, 150
exclusions/restrictions, 27, 114-115, 150, 151, 154-155, 156
implementation of practice guidelines, 5, 16, 22, 27, 41, 61, 70-71, 79, 113-119
and liability, 114 n.8, 132 n.23
medical review criteria and, 115-116
patient preferences and, 158
priority setting, 158-159
reforms related to, 22
types of decisions, 114-115
Benign prostatic hypertrophy, 55, 109, 179, 181
Blood transfusions, 34, 73, 158, 306
Blue Cross and Blue Shield Association, 60-61, 113, 154, 156, 169
Board certification, 86-87
Breast cancer, 59, 140, 181, 182 n.8, 184
Brigham and Women's Hospital, 93
C
Canada, College of Family Physicians, 101
Canadian Task Force, 173-174, 178
Cardiac technologies, 108, 170
Cardiovascular care, 48, 54, 56, 60
Carotid endarterectomy, 60, 108, 280
Center for Health Economics Research, 56
Centers for Disease Control, 54-55, 260
Chest pain management, 170, 270
Children's Hospital (Pittsburgh), 56
Clinical practice guidelines applications, 2, 8, 14-18, 23, 30, 40 , 196-197
see also Implementation of practice guidelines appropriateness criteria distinguished from, 60
as benchmarks for performance, 15, 73, 96, 110
and clinical flexibility, 8, 30, 368-371
clinically oriented, 36
complexity, 36
context for understanding, 2, 24
and cost containment, 2, 3-4, 21, 23, 36-37, 99;
see also Cost management
credibility of, 5, 11, 45, 198
distinguished from reimbursement or coverage policies, 2-3
educational opportunities in, 10
evaluation of impact of, 6
expectations about, 4, 23, 24, 38-39, 42-43
fears about misuse of, 23-24
funding for, 5
and health care reform, 21-22
and informed patient decision making, 2, 32
legal implications, 49-50;
see also Medical malpractice
limitations of current efforts, 6, 10, 42, 199
policy makers' interests in, 3-4, 5, 23, 27, 36-39, 198
presentation of, 10
reliability/reproducibility, 8, 30, 372-374
scheduled review, 398-399
statutory recognition of, 17-18, 207
strengths of current efforts, 5-6, 198
study committee membership and
activities, 25-26
translation into medical review criteria, 6, 40, 56, 107
types of, 36
variations in, 243-244
see also Development of practice guidelines
Clinical trials of clinical alert/reminder system, 91
weight of scientific evidence from, 178
Common Diagnostic Tests,143, 169, 275
Common Screening Tests,143, 169
Computers/computerization, 24
advances in, 92-93
and application of guidelines, 18
ARDEN syntax, 92-93
assessment of guidelines, 90
clinical reminders and alerts, 73, 90-91, 95
compatibility/linkages between systems, 9, 92-93, 94, 97
constraints on, 91-92
costs, 92
current systems, 90-92
data collection and analysis strategies, 93
and development of guidelines, 93-94
directions for, 96-98
dissemination of guidelines, 90, 188-190, 208
educational applications, 89
impacts of, 91
information systems, 90-94, 96-98
integrated data bases, 73, 95-96
interactive videos, 89, 181, 194
Medical Logic Module, 311
medical records, 73, 90, 92, 95, 97, 140
medical review criteria algorithms, 109-110
National Library of Medicine, 18, 94, 96-97, 165, 188, 189, 191, 208
outcomes data, 95
quality improvement programs, 72-74, 102 n.2, 140
review and revision of guidelines, 95, 95
self-teaching modules, 88
translation of guidelines for use on, 92-93, 97, 182, 208
Uniform Clinical Data Set, 58
user-friendliness, 80-81, 92, 207-208
voice recognition systems, 81, 93, 97
Conflicting guidelines, 35, 183-184
Congestive heart failure, 56, 166
Continuous quality improvement, 5
administrative focus of, 104-105
deficiencies in, 111
feedback to physicians, 103, 105
by hospitals, 102
implementation of medical review criteria in, 107
implementation of practice guidelines in, 2, 15, 62, 70-74, 103-104, 205-206
JCAHO implementation of, 102
liability problems, 134
as a management strategy, 72-74
testing and modification of guidelines, 10, 24
Coronary artery bypass surgery, 49, 60, 105, 170, 323
Cost management benefit coverage determinations. 5, 16, 70, 113-119
consumer incentives, 122
credentialing and selection of practitioners, 16, 119-121
development of guidelines, 7, 12-13, 21-22, 32, 52, 80, 140-146
economic incentives, 16, 121-122
implementation of practice guidelines for, 2, 3-4, 16-17, 21, 36-37, 38-39, 41, 42, 70-71, 135, 140-146, 206-207
incentives for economy and efficiency, 39, 121-122, 123
integrated financial and clinical
management computer systems, 95-96
medical review criteria and, 115-116, 206
prior review and, 115-116
proposed directions for, 123
tort liability concerns, 116-119
utilization review and, 116
Costs of health care defensive medicine, 125 n.17
implications included in guidelines, 12-13, 21-22, 135-136, 140-146
and minimum levels of care, 12-13
Council of Medical Specialty Societies, 49, 168
Coverage, see Benefit coverage
Critical pathways, 75, 105, 186-187
D
Decision modeling, 48
Definitions and terminology appropriateness of care, 28. 33, 154, 155
"basic benefits,"; 13, 154-157
clinical practice guidelines, 2-3, 26-27
concerns about, 155-156
"guidelines,"; 33
"indicated,"; 154
"medical necessity,"; 13, 154-155, 160
medical review criteria, 2, 27
"minimum care,"; 12-13, 154, 157-159
"necessary,"; 154-157
"options for care,"; 33
"standards for care,"; 33, 127, 133
"strong evidence,"; 33
Development of practice guidelines algorithms, 61-62, 181
appropriateness criteria converted into, 60
attributes of guidelines considered in, 29, 49, 111, 116
benefit-harm determinations of alternative
courses of care, 31
building a compelling case for
chairperson, 165
clinician participation in, 15
computer applications for, 93-94
consensus approaches, 33-34, 54, 60, 61, 63, 164, 166-168, 176
cooperative actions in, 48-49, 60-61, 168-170
cost-effectiveness considerations, 7, 12-13, 21-22, 32, 52, 80, 140-146
costs of, 62-63, 165, 181, 199, 203-204
desirable attributes of, 7, 8, 28-30
dissemination concerns, 168 n.3
documentation of, 8, 30, 45, 47 n.2, 90, 132, 136, 144, 168 n.3
evidentiary foundation, 4, 7, 24, 29, 31, 32-35, 38, 45, 104, 126, 132, 136, 145, 164, 168 n.3, 178-179
and implementation of guidelines, 7, 11-12, 45-46, 163-164, 183-192, 201-203
improvements in, 6-14, 199-204
inconsistency and confusion in, 11, 13, 26-27, 28, 35, 76-77, 181-183, 202
see also Definitions and terminology
liability considerations, 116-117, 118-119
multidisciplinary process, 9, 30, 45, 167
organizational processes, 164-170, 176-178
panel creation and member selection, 170-171, 176-178
patient preferences considered in, 31, 68-69. 148-150, 151, 167, 180-181, 199
payer interest in, 112-113
pluralism and diversity in, 5, 6, 42, 46-47, 181-182, 198, 199
priority setting in, 57, 104, 175-176
by private-sector organizations, 59-62
by professional organizations, 1, 5, 46-52
by public agencies, 52-59;
see also individual agencies
quality control in, 6, 16, 199
quantitative/modeling approach, 176
and research targeting, 35
resources for, 6
revision/updating, 8, 30, 32, 35, 38, 45, 90, 95, 168 n.3, 173-174
"sunset" provisions, 173
testing and modification, 10, 20;
see also Assessment of practice guidelines
time commitment, 165
training for, 168
volume of efforts, 39, 42, 163-164
see also Formats of guidelines:
Local adaptation of guidelines;
Methodological issues
Diabetic retinopathy, 169-170
Dietary cholesterol recommendations, 32
Dysuria, 333
E
Education computer applications in, 88, 89
conferences for guideline users, 16, 110-111
evaluation of programs, 109
impact and cost-effectiveness, 88-89
implementation of practice guidelines in, 67, 72-74, 78, 86-90
informal processes, 89
interactive videos, 89, 181, 194
on needs of patients, 89
operations-level feedback, 88, 110
opportunities in development of practice
guidelines, 10
outreach programs, 55
personal, interactive strategies, 88
of practitioners, 16, 88, 109, 110, 123
reimbursement for, 89
small-group strategy, 88
training in assessment of guidelines. 84
training of guidelines developers, 168
Emergency room care, 125, 130, 131, 170, 270
End-stage renal disease. 31 n.6
Erythrocyte sedimentation rate tests in diagnosis, 275
Ethical concerns cost-effectiveness considerations, 145-146
information provision to patients, 150-153
informed consent, 138. 147-148
and minimum care and basic benefits, 154-160
obligations of collective social systems. 138-140
obligations of individuals, 136-138
paternalism, 137-138
patient autonomy, 137, 148, 149
patients in persistent vegetative states, 149
terminally ill patients, 138, 149
F
Food and Drug Administration, 53
Formats of guidelines, 167
computer-based, 73, 189, 251, 296, 311, 317
critical pathways, 323
defined, 36
and dissemination, 12, 188-189, 202-203
formalized presentations, 246-251
flowcharts and similar styles, 248-249, 264, 311, 317, 321
free text, 245-246, 252, 260, 264, 270, 275, 280, 288, 296, 306, 328, 336
standards proposed, 249-251
G
Group Health Cooperative of Puget Sound, 139-140, 186
H
Harvard Community Health Plan Clinical Guidelines Program, 61-62, 333
computer link to Brigham and Women's Hospital, 93
Health care institutional implementation of guidelines, 67, 74-76
rationing of, 139
reforms, 21-22, 135, 156-157, 217-219
"two-tier,"; 160
Health Care Financing Administration, 57-58, 60, 108, 179 n.5
Health examinations, periodic, 59
Health insurance competition and consumer choice among plans, 22, 131-132
deductibles and cost sharing, 121
practice guidelines as mechanism for defining, 5
right to information on treatment options, 150-151
see also Benefit coverage
Health maintenance organizations, practice guidelines, 61-62, 67, 113
Health status assessment, 179-180
Holston Valley Hospital, 323
Hospitals clinical pathways or protocols, 105
continuous quality improvement by, 102, 105
implementation of practice guidelines, 74-75, 78, 79
retrospective utilization review programs, 115
Human immunodeficiency virus, universal precautions, 27-28
Hypertension screening, 31 n.6, 54
Hypertension treatment program, 89
I
Immunization practices, 54, 55, 59, 151, 182 n.8, 260
Implementation of practice guidelines, 25
by academic medical center hospital, 72-74, 78
and behavioral change, 14, 72-74
case studies, 67-77
in certification and re-certification of physicians, 86-87, 101
challenges to, 65-77
clinical research role, 84
by community hospitals, 74-75, 78, 79
conditions for success in, 14-18, 84-85
context considerations, 84
continuous quality improvement applied to, 104
in cost management, 16-17, 27, 36-37, 38-39, 41, 70-71, 99-100, 112-123, 135, 206-207
in credentialing of practitioners, 119-120
dissemination strategies, 12, 54, 87, 94, 170, 188-192, 203
educational conferences for users, 16, 110-111
for educational purposes, 41, 72-74, 78, 86-90
environmental factors in, 79
format and specificity and, 68-69
and human errors, 76-77
information and decision support systems, 18, 68-69, 72-74, 80-81, 207-208
institutional factors in, 78-79
interface between development and, 11-12, 45-46, 78, 163-164, 201-203
in internal medicine practice. 68-69
by managed care organization, 70-71, 79
in management decision making and follow-through, 74-75
medical liability and, 41, 51, 67, 74-75, 125-132, 207-208
by nurses and nurse-practitioners, 40
by nursing homes and hospices, 75-76, 78, 79
patient needs, characteristics, and
preferences and, 68-69, 74-75, 78, 79, 145
by patients, 39, 40, 76-77, 78, 87, 89
by physicians/practitioners, 23, 40, 41, 66, 67, 78, 153-154
practice variation and, 72-74
for preventive services, 139-140
in quality assurance and improvement, 2, 15-16, 27, 37, 41, 72-74, 205-206
regulation and interpretation of guidelines, 75-76
requirements for. 42
in risk management, 17-18, 37, 41, 51, 74-75, 100, 207-208
strategies to encourage, 79-81, 87
tasks, 65
time constraints, 68-69
training programs, 110
Incentives, economic, 72-75
Inconsistent guidelines, 35, 183-184
Independent practice associations, 67, 121
Information systems, see Computers/ computerization
British standard, 147 n.6, 151 n.8
defined, 147
ethical concerns, 138
and patient preferences, 147, 151-152
and risk management, 147
Informed patient decision making, 2, 5
as a goal of practice guidelines, 15, 23, 32, 41, 103, 125
guidelines for, 13-14, 28, 152-153, 204
and informed consent, 148
patient preferences and, 145, 148-150
responsibilities for provision of
information, 151-152
risk management and, 125
Intermountain Health Systems (Salt Lake City), 96
Internal Medicine Center to Advance Research and Education, 172-173
Internal medicine practice, 68-69, 78
International Society for Technology
Assessment in Health Care, 168 n.3
Interstudy, Outcomes Management System, 120-121, 179 n.5
J
John A. Hartford Foundation, 60, 166, 168
Johns Hopkins University Program for Medical Technology and Practice Assessment , 86
Joint Commission on Accreditation of Health care Organizations, 28 , 71, 102
K
Kaiser Permanente, 62
L
Labor and delivery after previous cesarean section, 296
Latter Day Saints Hospital (Salt Lake City), 91
Litigation benefit coverage, 114 n.8
medical liability, 114 n.9, 117
Pirozzi v. Blue Cross and Blue Shield of Virginia,114 n.8, 117 n.11
Rollo v. Blue Cross-Blue Shield of New Jersey,117 n.11
Salgo v. Leland Stanford Junior University Board of Trustees,147
Wickline v. California,114 n.9, 117, 118
Wilson v. Blue Cross of California,114 n.9, 118
Local adaptation of guidelines case studies, 70, 72-74, 75-76
and conflict and inconsistency, 183-184
evidentiary foundation of guidelines and, 32
processes for, 6, 186-187, 199, 202
reasons for, 11-12, 184-186, 202
and stature of guidelines, 187-188
M
Maine, medical liability demonstration project, 130
Managed care organization, 70-71, 79
Maryland Hospital Association, quality indicator project, 102
Massachusetts General Hospital (Boston), 91
Massachusetts, risk management strategy, 131, 270
Mayo Clinic, 60
length-of-stay criteria, 118
Oregon reforms, 157
Medical malpractice continuous quality improvement models and, 134
contract language for HMOs, 132 n.23
customary practice, 127
decision making reforms, 22
"defendent use only" aspect of guidelines, 130-131, 133
and defensive medicine, 125 n.17, 126
defined, 127-128
duty of care, 117-118
hearsay evidence, 128
immunity from liability, 17, 117 n.11, 128, 129, 130, 132, 133, 187 , 207
implementation of practice guidelines and, 41, 51, 67, 74-75, 100, 125, 126
informed consent and, 147
insurance premiums, 51, 125, 131
"learned treatises,"; 128
local adaptation of guidelines and, 187-188
physician responsibility for care, 118
research on. 133
standard-of-care determinations, 127, 128-132
"strict locality rule" and "similar locality rule."; 127
underwriters' development of guidelines, 51
variation in, 58
weight of guidelines in decision making on, 17, 128-132, 207
see also Litigation:
Risk management
Medical necessity, 13
Medical review criteria appeals criteria, 9, 112
and benefit cost management, 115-116
computerization. 9, 109-110, 112
criticisms of, 17, 58, 69, 107-108, 116, 207
desirable attributes of, 7, 9, 17, 28, 111, 112, 116, 123, 206
evaluation of, 109
implementation issues. 107-108
patient responsiveness to, 9, 112
patterns-of-care focus, 107
private sector implementation, 109-110
public sector implementation of, 108-109
translation of practice guidelines into, 6, 55-56, 107, 199
Medicare, 113
carriers and fiscal intermediaries, 107
controls on payments, 37
defensive medicine costs, 125 n.17
medically necessary care standard, 155, 159
reimbursement policies, 27, 156
Medicare Peer Review Organizations (PROs) criticisms of, 132
defined, 57-58
implementation of practice guidelines, 67
liability of, 129
review criteria, 17, 55, 58, 107-108, 133
utilization review activities, 108
The Merck Manual,62
Metabolic acidosis, 311
Methodological issues, 200-201
algorithmic analysis, 182
analytical strategy for guidelines
conflicts and inconsistencies in guidelines, 181-183
cost-effectiveness analysis and estimation, 141-142
evaluation of scientific evidence, 178-179
expert panel processes, 176-178
patient preferences incorporated into
guidelines, 180-181
problems, 39
research needs, 174-183
topic selection, 175-176
Micromanagement of professional and institutional behavior, 17, 23 , 123
Minimum Care, 154-159
Minnesota Clinical Comparison and Assessment Project, 61
N
National Cholesterol Education Program for Adults, 54
National Demonstration Project on Quality Improvement in Health Care , 102
National Heart, Lung, and Blood Institute, 54
National High Blood Pressure Education Program, 54
National Institutes of Health Consensus Development Conference Program , 54, 167-168, 175
Office of Medical Applications in Research, 53-54. 63, 167
National Library of Medicine (NLM), 18, 27, 94, 96-97, 165, 188, 189, 191, 208, 214
New England Medical Center hospitals (Boston), 96, 323
Nursing homes and hospices, 75-76, 78, 79, 138-139
O
Obstetrics and gynecology guidelines, 48, 49, 87, 130
Office for Health Services Research Information, 18, 208
Office of Health Technology Assessment, 176
Office of Technology Assessment, 59
Omnibus Budget Reconciliation Act of 1989, 55, 56, 65 n.1, 94, 175 , 179
Oral contraceptives, 317
Oregon Basic Health Services Act, 157
Otitis media in children, 56, 166
Outcomes of care, 5
continuous quality improvement and, 104
incorporation in practice guidelines, 179-180
Interstudy Outcomes Management System, 120-121
methodologic concerns, 179-180
patient preferences, 148
in patient satisfaction surveys, 15, 103
practice guidelines and, 15, 95, 100
research on, 5, 37-38, 42, 56-57
uncertainties about, 37-38
P
Pain management, 55, 76, 109, 170, 191 n.,11, 270, 336
Patients autonomy, 137, 138, 148-150
economic incentives for cost containment, 16
guidelines content for, 32, 252, 260, 296, 306, 321
implementation of practice guidelines, 39, 40, 66, 67, 76-77, 78, 79, 87
information on cost control incentives, 121-122
noncompliance with treatment regimen, 89
preferences, 29, 31, 103, 145, 147, 148-150, 158, 180-181
satisfaction with care, 15, 103
see also Informed patient decision making
Peer Review Organizations, see Medicare Peer Review Organizations
Pew Memorial Trust, 60
Physician-patient relationship, 89, 138
Physician Payment Review Commission, 49
Physicians availability of computer-based information systems, 93
behavioral change, 72-74, 85, 88
certification and re-certification of, 86-87, 101
feedback to, 70-71, 72-74, 88, 103, 105, 110, 123, 172
implementation of guidelines, 23, 40. 41. 66, 67, 78, 153-154
licensure conditions, 131
see also Practitioners
Physicians' Desk Reference,62, 69, 76
Poststroke rehabilitation, 56, 166
Practitioners attitudes about prior review programs, 115-116
economic incentives for cost containment, 16
educational strategies for, 88, 109
ethical obligations to patients, 136-137
objections to practice guidelines, 24
performance evaluation, 61
selective contracting, 16, 120-121
variations in practice patterns, 37
Preferred provider organizations, 113, 121
President's Commission for the Study of Ethical Problems in Medicine and Bio- medical and Behavioral Research, 147
Pressure sores, prevention, 75
Preventive interventions, 58-59, 71, 139-140, 158
Prior review programs, 115
Professional organizations development of guidelines. 1, 5, 6, 47-52. 168-170
focus of. 47
interests in practice guidelines, 50-52
see also individual organizations
Prospective preprocedure and preadmission criteria, 17. 58, 109, 206
Psoriasis, 328
Q
Quality assessment. 5, 41, 107
Quality assurance Appropriateness Evaluation Protocol. 57
benchmarks for performance, 15
conceptual framework, 101
educational strategies and, 87
evaluations of performance and outcomes
data, 16
feedback to practitioners, 16
implementation of practice guidelines for, 37, 41, 205
proposed directions for, 110-111
revision/updating of guidelines, 16
tests of clinical skills, 101
see also Continuous quality improvement
Quality control, in guidelines development, 6
Quality improvement, see Continuous quality improvement;
Total quality management
Quality of care defined, 100
management commitment to, 103
practice guidelines and, 23, 99, 100
R
Radiology guidelines, 48, 49, 130
RAND Corporation, 36, 56, 57. 60, 109, 155, 169, 280
Regenstrief Medical Record System, 90
Report on Medical Guidelines & Outcomes Research,189
Research agenda adoption and diffusion of medical innovations, 21, 35, 216
assessment instrument, 21
conflicts and inconsistencies in guidelines, 181-183, 216
expert panel processes, 176-178, 216
impact of practice guidelines, 21, 35, 104, 216-217
incorporating outcomes information into guidelines, 179-180
medical liability, 133
methodologies for evaluating scientific evidence, 178-179, 216
on outcomes and effectiveness of health care services. 3, 24, 38, 42, 56-57, 104, 215-216
patient preferences, 180-181
testing effectiveness of practice guidelines, 21, 216
topic selection, 175-176
Retrospective review of care, 17
Risk management computer applications in, 95
educational strategies and, 87
implementation of practice guidelines in, 17-18, 37. 41, 51, 74-75, 100, 124-125
informed consent and, 147
physician conditions of licensure, 131
see also Medical malpractice
Robert Wood Johnson Foundation, 60, 102
Scientific American Medicine,62
Selective contracting, 70-71
Society for Medical Decision Making, 50
Society of Nuclear Medicine, 49
Sweden, clinical practice guidelines, 35
T
Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures, 48-49
Terminology, see Definitions and terminology
Third-party payers implementation of practice guidelines by, 5, 16 , 22, 27, 41
liability for negligence, 117
Total quality management, 102, 104-105
Triage of injured patients, 145, 264
U
United Health Care, 62
Universal precautions, 27-28
Urinary incontinence, 55, 109, 333
U.S. Health Care, 62
U.S. Preventive Services Task Force, guidelines, 34, 58-59, 63, 172 , 252
U.S. Public Health Service, guidelines development, 53-57, 143, 172
Utilization review appropriateness criteria, 57
concurrent review of inpatient care, 115, 117
and cost control, 116
criticisms of, 107-108
by hospitals, 115
implementation of practice guidelines, 116, 206-207
medical review criteria in, 107
retrospective, 115
role of, 17, 70-71, 101, 123, 207
by third-party payers, 115
V
Vaccinations for pregnant women, 55, 260
Value Health Sciences, 60
definition of appropriate care, 155
Medical Review System, 109
Visual acuity screening of children, 59, 252
W
Wishard Memorial Hospital, 90