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 ThemesPI 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