Clinical Guidelines and Performance Measures: Responsible Guidance and Accountability
The following are 10 points to remember about clinical guidelines and performance measures:
1. Each guideline represents a summary and synthesis of the available evidence by a writing committee, which is vetted through an exhaustive process of peer review and approval by the Task Force on Practice Guidelines (TFPG), the Board of Trustees of the American College of Cardiology Foundation (ACCF), and the Science Advisory Coordinating Committee of the American Heart Association (AHA), in addition to the governing bodies of relevant partnering organizations.
2. Studies have shown that practice according to ACCF and AHA guideline recommendations is associated with improved patient outcomes.
3. Currently, changes to the evidence review, a specific evidence scoring system, the addition of Bayesian analysis, and shorter formats are being evaluated as enhancements to the guideline writing process.
4. Not all guideline recommendations are appropriate for performance measurement.
5. Performance measures must be valid, reliable, actionable, and measurable, and they must address a demonstrable gap in care.
6. Although the strongest guideline recommendations define candidates for performance measurement, only those processes that meet a number of other criteria will ultimately be considered appropriate for the purposes of accountability after the application of an explicit and rigorous methodology.
7. U.S. health care has moved beyond the question of whether performance should be measured; the focus now is how measurement will be conducted.
8. As professionals, we have an obligation to define best practices on the basis of the evidence, to measure how consistently these practices are being used in our patients, and to stimulate future quality improvement efforts that promote safe and effective care and maximally improve patient outcomes.
9. The ACCF and AHA have an explicit, and relatively stringent, policy on relationships with industry and other entities for writing group membership, including restrictions on the number of writing group members who can have relevant conflicts and restricting the writing and voting on specific sections of the documents to those individuals without relationships relevant to these sections.
10. Overall, guidelines and performance measures generated by the ACCF and AHA provide clinicians with methodologically rigorous and practical tools to support their practice.
Keywords: Quality Improvement, Trustees, Cardiology, Social Responsibility, Immunosuppressive Agents, Peer Review, Bayes Theorem, Sirolimus, United States
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