Guideline (medical)
Encyclopedia
A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine
.
However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine
. They usually include summarized consensus statements
on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of his or her profession, and has to decide whether or not to follow the recommendations of a guideline for an individual treatment.
Modern clinical guidelines identify, summarize and evaluate the highest quality evidence and most current data about prevention
, diagnosis
, prognosis
, therapy including dosage of medications, risk/benefit
and cost-effectiveness
. Then they define the most important questions related to clinical practice and identify all possible decision options and their outcomes. Some guidelines contain decision or computation algorithms to be followed. Thus, they integrate the identified decision points and respective courses of action to the clinical judgment and experience of practitioners. Many guidelines place the treatment alternatives into classes to help providers in deciding which treatment to use.
Additional objectives of clinical guidelines are to standardize
medical care, to raise quality of care, to reduce several kinds of risk (to the patient, to the healthcare provider, to medical insurers and health plans) and to achieve the best balance between cost and medical parameters such as effectiveness
, specificity, sensitivity, resolutiveness, etc. It has been demonstrated repeatedly that the use of guidelines by healthcare providers such as hospitals is an effective way of achieving the objectives listed above, although they are not the only ones.
Special computer software
packages known as guideline execution engine
s have been developed to facilitate the use of medical guidelines in concert with an electronic medical record
system.
The Guideline Interchange Format (GLIF) is a computer representation format for clinical guidelines that can be used with such engines.
It has been found that some simple clinical practice guidelines are not routinely followed to the extent they might be. It has been found that providing a nurse or other medical assistant with a checklist
of recommended procedures can result in the attending physician being reminded in a timely manner regarding procedures that might have been overlooked.
Guidelines are usually produced at national or international levels by medical associations or governmental bodies, such as the US Agency for Healthcare Research and Quality. Local healthcare providers may produce their own set of guidelines or adapt them from existing top-level guidelines.
The USA and other countries maintain medical guideline clearinghouses. In the USA, the National Guideline Clearinghouse maintains a catalog of high-quality guidelines published by various organizations (mostly professional physician organizations) . In the United Kingdom, clinical practice guidelines are published primarily by the National Institute for Health and Clinical Excellence
(NICE). In The Netherlands, two bodies (CBO and NHG) publish specialist and primary care guidelines, respectively . In Germany, the German Agency for Quality in Medicine
(ÄZQ) coordinates a national program for disease management guidelines. All these organisations are now members of the Guidelines International Network
(G-I-N), an international network of organisations and individuals involved in clinical practice guidelines. G-I-N is owner of the International Guideline Library – the largest web based data base of medical guidelines worldwide - and pursue a set of activities aiming at promoting best practice and reducing duplication.
History of medicine
All human societies have medical beliefs that provide explanations for birth, death, and disease. Throughout history, illness has been attributed to witchcraft, demons, astral influence, or the will of the gods...
.
However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
. They usually include summarized consensus statements
Consensus (medical)
Medical consensus is a public statement on a particular aspect of medical knowledge available at the time it was written, and that is generally agreed upon as the evidence-based, state-of-the-art knowledge by a representative group of experts in that area...
on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of his or her profession, and has to decide whether or not to follow the recommendations of a guideline for an individual treatment.
Modern clinical guidelines identify, summarize and evaluate the highest quality evidence and most current data about prevention
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
, diagnosis
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
, prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
, therapy including dosage of medications, risk/benefit
Risk-benefit analysis
Risk–benefit analysis is the comparison of the risk of a situation to its related benefits. Exposure to personal risk is recognized as a normal aspect of everyday life. We accept a certain level of risk in our lives as necessary to achieve certain benefits. In most of these risks we feel as though...
and cost-effectiveness
Cost-effectiveness
Cost-effectiveness analysis is a form of economic analysis that compares the relative costs and outcomes of two or more courses of action. Cost-effectiveness analysis is distinct from cost-benefit analysis, which assigns a monetary value to the measure of effect...
. Then they define the most important questions related to clinical practice and identify all possible decision options and their outcomes. Some guidelines contain decision or computation algorithms to be followed. Thus, they integrate the identified decision points and respective courses of action to the clinical judgment and experience of practitioners. Many guidelines place the treatment alternatives into classes to help providers in deciding which treatment to use.
Additional objectives of clinical guidelines are to standardize
Standardization
Standardization is the process of developing and implementing technical standards.The goals of standardization can be to help with independence of single suppliers , compatibility, interoperability, safety, repeatability, or quality....
medical care, to raise quality of care, to reduce several kinds of risk (to the patient, to the healthcare provider, to medical insurers and health plans) and to achieve the best balance between cost and medical parameters such as effectiveness
Effectiveness
Effectiveness is the capability of producing a desired result. When something is deemed effective, it means it has an intended or expected outcome, or produces a deep, vivid impression.-Etymology:...
, specificity, sensitivity, resolutiveness, etc. It has been demonstrated repeatedly that the use of guidelines by healthcare providers such as hospitals is an effective way of achieving the objectives listed above, although they are not the only ones.
Special computer software
Computer software
Computer software, or just software, is a collection of computer programs and related data that provide the instructions for telling a computer what to do and how to do it....
packages known as guideline execution engine
Guideline execution engine
A Guideline Execution Engine is a computer program which can interpret a clinical guideline represented in a computerized format and perform actions towards the user of an electronic medical record....
s have been developed to facilitate the use of medical guidelines in concert with an electronic medical record
Electronic medical record
An electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...
system.
The Guideline Interchange Format (GLIF) is a computer representation format for clinical guidelines that can be used with such engines.
It has been found that some simple clinical practice guidelines are not routinely followed to the extent they might be. It has been found that providing a nurse or other medical assistant with a checklist
Checklist
A checklist is a type of informational job aid used to reduce failure by compensating for potential limits of human memory and attention. It helps to ensure consistency and completeness in carrying out a task...
of recommended procedures can result in the attending physician being reminded in a timely manner regarding procedures that might have been overlooked.
Guidelines are usually produced at national or international levels by medical associations or governmental bodies, such as the US Agency for Healthcare Research and Quality. Local healthcare providers may produce their own set of guidelines or adapt them from existing top-level guidelines.
The USA and other countries maintain medical guideline clearinghouses. In the USA, the National Guideline Clearinghouse maintains a catalog of high-quality guidelines published by various organizations (mostly professional physician organizations) . In the United Kingdom, clinical practice guidelines are published primarily by the National Institute for Health and Clinical Excellence
National Institute for Health and Clinical Excellence
The National Institute for Health and Clinical Excellence is a special health authority of the English National Health Service , serving both English NHS and the Welsh NHS...
(NICE). In The Netherlands, two bodies (CBO and NHG) publish specialist and primary care guidelines, respectively . In Germany, the German Agency for Quality in Medicine
German Agency for Quality in Medicine
The German Agency for Quality in Medicine - in German "Ärztliches Zentrum für Qualität in der Medizin ", established in 1995 and located in Berlin co-ordinates healthcare quality programmes with special focus on evidence-based medicine, medical guidelines, patient empowerment, patient safety...
(ÄZQ) coordinates a national program for disease management guidelines. All these organisations are now members of the Guidelines International Network
Guidelines International Network
The Guidelines International Network is an international scientific asssociation of organisations and individuals interested and involved in development and application of evidence based guidelines and health care information...
(G-I-N), an international network of organisations and individuals involved in clinical practice guidelines. G-I-N is owner of the International Guideline Library – the largest web based data base of medical guidelines worldwide - and pursue a set of activities aiming at promoting best practice and reducing duplication.
Examples
- The American Heart AssociationAmerican Heart AssociationThe American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
Guidelines for the PreventionDental antibiotic prophylaxisDental antibiotic prophylaxis is the admission of antibiotics to a dental patient for prevention of harmful consequences of bacteremia, that may be caused by invasion of the oral flora into an injured gingival or peri-apical vessel during dental treatment...
of Infective EndocarditisInfective endocarditisInfective endocarditis is a form of endocarditis, or inflammation, of the inner tissue of the heart, such as its valves, caused by infectious agents. The agents are usually bacterial, but other organisms can also be responsible....
See also
- Clinical prediction ruleClinical prediction ruleA clinical prediction rule is type of medical research study in which researchers try to identify the best combination of medical sign, symptoms, and other findings in predicting the probability of a specific disease or outcome....
- Clinical trial protocolClinical trial protocolA clinical trial protocol is a document that describes the objective, design, methodology, statistical considerations, and organization of a clinical trial...
- Treatment Guidelines from The Medical LetterTreatment Guidelines from The Medical LetterTreatment Guidelines from The Medical Letter is published monthly by the non-profit organization The Medical Letter, Inc., which also publishes The Medical Letter on Drugs and Therapeutics. The journal provides reviews of drug classes for the treatment of most primary care disorders, such as...
External links
- British Columbia Medical Guidelines - In Canada, British Columbia's guidelines and protocols are developed under the direction of the Guidelines and Protocols Advisory Committee (GPAC), jointly sponsored by the B.C. Medical Association and the B.C. Ministry of Health Services.
- The Cochrane Collaboration - The Cochrane Collaboration is an international, independent, not-for-profit organisation of over 27,000 contributors from more than 100 countries, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide.
- Guideline Elements Model - The Guideline Elements Model (GEM) is an ASTM standard for the representation of practice guidelines in XML format.
- Guideline Interchange Format - The Guideline Interchange Format (GLIF) is a specification for structured representation of guidelines.
- Guidelines International Network. Contains the largest online guideline library.
- Hospital Quality Alliance - A project of the Hospital Quality Initiative (HQI) of the Centers for Medicare and Medicaid Services.
- National Guideline Clearinghouse (NGC), a public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and QualityAgency for Healthcare Research and QualityThe Agency for Healthcare Research and Quality is a part of the United States Department of Health and Human Services, which supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective...
(AHRQ), U.S. Department of Health and Human Services - Scottish Intercollegiate Guidelines Network (SIGN). Contains 113 evidence-based clinical guidelines – published, in development, or under review.