Evaluating guidelines: An important step in improving cancer care

Freestanding patient management guidelines have had a minimal impact on phy sician behavior. Their passive distribution and implementation have proven to be no more effective than conventional medical education programs. Evalu ating compliance with guidelines, providing feedback to physicians, and ass essing the impact on clinical, social,and economic outcomes is critical to optimal use of the guidelines. The acceptance and implementation of patient management guidelines will depend on the probable benefits and outcomes. T he orderly structure and appeal of the guidelines, coupled with claims rega rding their ease of application, cannot replace a substantive evaluation. M ethods for evaluating guidelines may include (1) conducting patient and phy sician surveys, (2) measuring general compliance to recommendations on majo r decision points, (3) abstracting information from clinical records, (4) u sing payer data to determine resource use, and (5) using cancer registry da ta to follow outcomes. The application of guideline recommendations without an evaluation of their influence on patient outcomes provides minimal bene fit at an extremely high cost. Information from evaluations must be fed bac k to practitioners, and particularly to local "opinion leaders." The goal o f guideline implementation should be to improve practice patterns and ultim ately patient outcomes. Physicians should be certain that the guidelines wi ll improve the care of their patients, and they should also receive the adm inistrative support they need to ease guideline application. Health mainten ance organizations have used financial incentives and disincentives to enco urage compliance with guidelines, with some degree of success. The success of clinical management guidelines is a complex effort that varies greatly d epending on local conditions. Improvements in guideline compliance will req uire the use of multiple interventions tailored to the local practice envir onment.