FROM PAPER TO PRACTICE TO POINT OF CARE - REPORTS FROM A ZITTER GROUPCONFERENCE ON IMPLEMENTING PRACTICE GUIDELINES

This conference, originally titled ''implementing Practice Guidelines: A Focus on Changing Physician Behavior and Employing Technology,'' wa s held by the Zitter Group in Scottsdale, Arizona, January 21-23, 1996 . The Zitter Group is a San Francisco-based health care education and publishing firm that focuses on outcomes research, disease management, pharmacoeconomics, and health care quality improvement. Conference Go als The conference was designed to fulfill the following learning obje ctives: Distinguish between types of guidelines and identify appropria te applications for various settings of care; Explain methods for addr essing legal liability and risk-exposure issues related to practice gu ideline development and implementation; Describe the role of patient i nput into guideline development and implementation; Identify key succe ss factors and tools for achieving physician buy-in to quality improve ment and practice guideline implementation efforts; Identify technolog y applications for implementing practice guidelines; and Describe exam ples and tools for measuring patient outcomes and health care utilizat ion resulting from guide line implementation efforts. Conference Progr am and Participants The two-day conference of presentations, panels, a nd work-shops and breakout sessions was organized into three segments focusing on (1) securing physician buy-in and other dimensions of guid eline development and implementation, (2) using technology to integrat e guidelines into electronic systems, and (3) measuring the impact of guidelines on outcomes. A preconference workshop outlined the issues a nd drew out the various guideline-related needs and experiences of the conference participants, who for the most part were clinicians and wh o spanned a broad spectrum of experience with guidelines. Eleven prese ntations with the key resources and references of faculty with direct guideline implementation experience were summarized and adapted for th is journal issue. Six presentations survey the implementation issues o f engaging physicians through disease management strategy, understandi ng legal issues, checking implementability of guidelines to improve ph ysician compliance, incorporating patient preferences, creating physic ian profiling systems to encourage change, and interpreting the Maine experience with the affirmative defense. Three presentations explore a pproaches to integrating guidelines into existing information systems, developing and testing computerized decision support systems, and usi ng the electronic patient record at the point of care. Two presentatio ns recount processes for measuring the results of specific guidelines in terms of patients' outcomes from the perspectives of a large consul ting company and a large community health maintenance organization.