Practice guidelines and practicing medicine; are they compatible?

Article Abstract:

In this time of ever-increasing financial pressure on medical facilities and physicians, the economic value and appropriateness of nearly every aspect of clinical practice is under scrutiny. Physicians make many daily decisions regarding patient treatment that are derived from knowledge of the patient and the probable value of a test or treatment. But does the average physician really understand the cost-benefit advantage of one test or procedure over another for a particular patient? What is the trade-off between the experience of one physician who selects a treatment for a unique patient and a medical guideline for the treatment of a similar, but idealized patient culled from the experience of a group of physicians? Experience seems to be pushing medicine into the direction of medical guidelines as the standard of treatment decisions. Such guidelines would be oriented towards medical outcomes and, once adopted, the methods outlined would become the norm against which practice would be assessed. While improving outcome, rigid adherence to medical guidelines can lead to excessive costs. The development of medical standards must also be tied to elaborate data collection and analysis procedures that will insure that their value is maintained and kept current with new research and the introduction of new procedures. The author outlines many potential effects of the use of medical guidelines and standards. The collection of such data could lead to: a means for self-evaluation by individual physicians, providing "consumer/patient" information, revitalizing medical textbooks and increasing the importance of information science in medical school. This trend could allow licensing boards to evaluate performance when recertifying physicians. In addition, insurance companies could base their decisions of preferred provider designations on how well individuals or institutions meet acceptable standards. A patient and physician could be more effective in assessing the patient's medical condition together. The legal system could use the standards to develop more appropriate definitions of malpractice and, as a result, malpractice claims and costs could be reduced.

Medicine, Practice, Medical practice

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Quality assurance in capitated physician groups: where is the emphasis?

Article Abstract:

Quality assurance programs in capitated physician groups may focus more on some aspects of care than others. Ninety-four physician groups participating in a California network-model health maintenance organization reported on various aspects of their quality monitoring. Two-thirds monitored for overuse of services versus less than half for underuse. Half monitored for preventative services versus one-third for follow-up services for chronic diseases. One-quarter used reminders for preventative care versus 15% for chronic diseases. Greater longevity in practice, higher profitability, and a higher percentage of capitated patients were associated with more quality assurance activity.

Standards, Capitated payment systems (Medical care)

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Health system reform and quality

Article Abstract:

Physicians must learn new ways to measure the quality of health care now that the US health care system is moving away from fee-for-service toward managed care. Many managed care plans try to contain costs and this can affect people's health. Research has shown that quality of health care can be measured and the instruments to do so are very reliable. Quality of health care assessments should focus on process measures rather than outcomes.

Health aspects, Managed care plans (Medical care), Health care reform

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