A MODEL FOR PRACTICE GUIDELINE ADAPTATION AND IMPLEMENTATION - EMPOWERMENT OF THE PHYSICIAN

Background: Although the number of well-developed clinical practice gu idelines is increasing rapidly, the successful implementation of pract ice guidelines on a large scale has not yet occurred. At the Universit y of Michigan Medical Center, we model the process for implementation of practice guidelines and present the value added to clinical groups that undertake this process. Methods: Evaluation and selection of nati onally developed clinical practice guidelines are based on prospective ly determined criteria. Clinical champions are then recruited to lead teams in the adaptation of national guidelines to local circumstances and promote buy-in. Once optimal care has been defined by local clinic ians, appropriateness of medical practice can be evaluated effectively ; the definition of optimal care endorsed by local clinicians serves a s the benchmark for analyzing medical practice decisions. implementati on of guidelines occurs using leadership from clinical champions. Cont racts and package prices that reflect optimal care can also be develop ed. Finally, this work can be disseminated throughout a health care de livery network. This activity will promote the delivery of optimal and comprehensive medical care throughout the region. Results: The Medica l Center is now involved in eight separate practice guideline projects using this model. Conclusion: Important features of this model includ e 1) physician participation; 2) use of previously developed guideline s as a baseline (does not require development of practice guidelines d e novo); 3) review of historical data after guideline endorsement to p revent biased definition of optimal care; 4) focus on appropriateness, not mechanics, of care; 5) a process that complements critical pathwa y development; 6) development of a package price that reflects value p er unit service as well as strict cost competitiveness; and 7) a proce ss to strengthen relationships with network partners.