PubMed · 7550471
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J Kalbhen. 1995-10-05. Protocols--going down the clinical path.. https://pubmed.ncbi.nlm.nih.gov/7550471/
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Physicians must insure that care provided--whether it be preventive, diagnostic, therapeutic of palliative--is appropriate. Confronted with the swift development of medical progress and the tremendous quantity and uneven quality of available information on appropriateness of care, it is important to determine optimal strategies for identifying necessary, relevant and valid information in this respect. Medical care is considered appropriate if the expected benefits to the patient outweigh the potential risks. The ideal source of information concerning appropriateness of care stems from rigorously conducted, randomized, controlled trials and from systematic reviews of the literature, such as those prepared by the Cochrane Collaboration. Concerning treatment of low back pain, recent years have witnessed several groups active in preparing such rigorous systematic reviews. Different sources of information on appropriateness of care for back pain are presented in this article. Unfortunately, many reviews underline the absence of evidence for the effectiveness of most treatments now used in the treatment of low back pain. On the other hand, absence of proof of effectiveness, and, as often in medicine, elements other than the quality of evidence must enter into the decision to use or not to use various treatments. But this should not keep us from pursuing rigorous clinic research to improve the scientific basis of care provided to our patients suffering from low back pain.
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PURPOSE: We describe the impact of clinical practice guidelines (CPGs) on improvement in oncology treatment processes or outcomes. METHODS: We performed a comprehensive search of the literature from 1966 to the present and a directed review of the literature. RESULTS: Improvements have been demonstrated in compliance with evidence-based guidelines or evidence-based medicine, and in short-term length of stay, complication rates, and financial outcomes. The data suggest that patient satisfaction can be maintained despite a shorter length of stay. There has been one example of province-wide improvement in disease-free and overall survival of breast cancer patients coincident with the adoption of CPGS: The components of successful guidelines can be summarized as follows: (1) development is based on evidence, with the guideline formulated by key physicians in the group; (2) the guidelines are disseminated to all affected health care professionals for critique; (3) implementation includes direct feedback on performance to physicians or general feedback on system performance; and (4) there is accountability for performance according to the guidelines. This accountability can consist of voluntary peer pressure to conform to evidence-based medicine, and it does not require a financial reward or penalty. CONCLUSION: Some attempts to improve practice have been moderately successful in achievement of reduced health care costs, reduced hospital length of stay, and possibly improved outcomes. Other methods that are still in use have been demonstrated to have little effect. Programs that have not succeeded have relied on voluntary change in practice behavior without incentives to change or have had no accountability component. Further research is needed to assess how guidelines are enacted in organizations other than those demonstrably committed to improvement, ways to improve compliance of health care providers who are not committed to change, and methods to improve accountability.