Strategies to Improve Clinical
Practice Through Guidelines:
Experience from Recent Studies
Michael Cabana (UCSF)
Rebecca Beyth (University of Florida)
Kathy Berra (Stanford University)
Thomas Bailey (Washington University)
Benjamin Crabtree (Robert Wood Johnson Medical School)
Catarina Kiefe (University of Alabama at Birmingham)
Funded by the National Heart, Lung and Blood Institute
Clinical Practice Guidelines (CPGs)
• Systematically developed statements to
influence practitioner and patient decisions
about appropriate health care for specific clinical
circumstances.
• Potential impact:
– Change physician behavior to promote appropriate
use of interventions
– Improve the outcomes of medical care
– Reduce variation in medical care
• CPGs have limited effect despite efforts for
several decades (e.g., JNC and ATP)
Initiative History
• NHLBI released an RFA in 2001 to fund “Trials
Assessing Innovative Strategies to Improve
Clinical Practice through Guideline
Implementation in Heart, Lung, and Blood
Diseases.”
• 8 projects funded in 2002
• 3 additional projects funded in 2003
• Investigators have met several times to share
ideas, discuss barriers and lessons learned.
• Initiative includes requirement for sharing
approaches and disseminating tools and results.
Project Themes
PI
Project Theme
Bailey
Secondary prevention for hospitalized patients with CHD and use of statins for patients
hospitalized with DM and LDL > 100
Beyth
Treatment and management of thromboembolic disorders.
Cabana
Management of pediatric asthma.
Carter
Adherence to the JNC7 BP guidelines and improvement in BP control.
Cloutier
Utilization of disease management program for asthma.
Crabtree
Improving clinician and staff interaction, information sharing and decision making to
improve adherence to multiple guidelines.
Eaton
Optimal screening and management of cholesterol according to ATPIII guidelines.
Goff
Adherence to ATPIII and JNC-7 in the ambulatory care setting.
Kiefe
Treatment and 30 prevention of acute coronary syndromes
Rothschild
Appropriateness of inpatient transfusions.
Bodenheimer T, et al. JAMA 2002; 288:1775-1779.
Bodenheimer T, et al. JAMA 2002; 288:1909-1914.
Agenda
• Clinician behavior change
• Role of Informed, Empowered
Patient and Family in Improving
Clinical Practice through
Guidelines
• Integrating Information
Technology into clinical
practice: Tools for clinical
decision support and guideline
implementation
• Organizational Change and
Team Building
• Conclusions and Implications
Agenda
• Clinician behavior change
• Role of Informed, Empowered
Patient and Family in Improving
Clinical Practice through
Guidelines
• Integrating Information
Technology into clinical
practice: Tools for clinical
decision support and guideline
implementation
• Organizational Change and
Team Building
• Conclusions and Implications
Agenda
• Clinician behavior change
• Role of Informed, Empowered
Patient and Family in Improving
Clinical Practice through
Guidelines
• Integrating Information
Technology into clinical
practice: Tools for clinical
decision support and guideline
implementation
• Organizational Change and
Team Building
• Conclusions and Implications
Agenda
• Clinician behavior change
• Role of Informed, Empowered
Patient and Family in Improving
Clinical Practice through
Guidelines
• Integrating Information
Technology into clinical
practice: Tools for clinical
decision support and guideline
implementation
• Organizational Change and
Team Building
• Conclusions and Implications
Agenda
• Clinician behavior change
• Role of Informed, Empowered
Patient and Family in Improving
Clinical Practice through
Guidelines
• Integrating Information
Technology into clinical
practice: Tools for clinical
decision support and guideline
implementation
• Organizational Change and
Team Building
• Conclusions and Implications