PHASE-II OF THE AHCPR-SPONSORED HEART-FAILURE GUIDELINE - TRANSLATINGPRACTICE RECOMMENDATIONS INTO REVIEW CRITERIA

Background: In 1992, under the sponsorship of the U.S. Agency for Heal th Care Policy and Research, RAND assembled an expert panel to develop the Heart Failure Clinical Practice Guideline. Phase II of the effort was intended to identify which of the guideline's recommendations the panel felt were suitable for use in retrospective utilization review and quality assessment programs and to develop review criteria, perfor mance measures, and standards of quality for use in monitoring complia nce with those recommendations. Selection of recommendations: Selectin g guideline recommendations for translation into review criteria and u ltimately into standards of care was a multistep process comprising (1 ) identification of 34 recommendations from the guideline, (2) rating them on the basis of importance to quality of care and feasibility of monitoring, (3) review by a subcommittee and the full guideline panel, (4) translation into review criteria, and (5) further review and inpu t by panelists and peer and pilot reviewers, Finally, standards of car e (the minimum proportion of cases expected to be in accordance with g uideline recommendations) were determined to be 90%-95% for six of the final criteria and 75%-80% for the other two. Conclusion: Despite som e reservations, physicians and other health care professionals agreed to be held accountable for following a core set of guideline recommend ations for the treatment of heart failure. Substantial progress was ma de in identifying recommendations that panelists and reviewers were wi lling to endorse in utilization review activities, including adoption of improved documentation standards. The review criteria's major impac t may be the knowledge that the criteria are in place and that care is being monitored based on those standards.