Clinical practice guidelines in end-stage renal disease: A strategy for implementation

Clinical practice guidelines (CPGs) for end-stage renal failure (ESRD) were recently published, and represent a comprehensive review of available lite rature and the considered judgment of experts in ESRD. To prioritize and im plement these guidelines, the evidence underlying each guideline should be ranked and the attributes of each should be defined. Strategies to improve practice patterns should be tested. Focused information for each high prior ity guideline should be disseminated, including a synopsis and assessment o f the underlying evidence, the evidence model used to develop that guidelin e, and suggested strategies for CPG implementation. Clinical performance me asures should be developed and used to measure current practice, and the su ccess of changing practice patterns on clinical outcomes. Individual practi tioners and dialysis facilities should be encouraged to utilize continuous quality improvement techniques to put the guidelines into effect. Local imp lementation should proceed at the same time as a national project to conver t high priority CPGs into clinical performance measures proceeds. Patients and patient care organizations should participate in this process, and prof essional organizations must make a strong commitment to educate clinicians in the methodology of CPG and performance measure development and the techn iques of continuous quality improvement. Health care regulators should unde rstand that CPGs are not standards, but are statements that assist practiti oners and patients in making decisions.