Local implementation of clinical practice guidelines and continuous quality improvement: Challenges and opportunities

Implementing clinical practice guidelines (CPGs), disease management progra ms, and quality improvement projects requires an understanding of the trend s that will facilitate adoption at the local level. These trends include co nsumerism and the building of a national information technology infrastruct ure. The recommendations of the Presidential Advisory Commission on Consume r Protection and Quality in the Health Care Industry and the Institute of M edicine (IOM) report entitled "To Err Is Human: Building a Safer Health Sys tem" will frame developments and implementation. The relative roles and res ponsibilities of national entities, with coordination and integration of th ese activities with local efforts will need to be carefully orchestrated. U tilizing the Web to connect dialysis facilities, patients, and members of t he health care delivery team has the potential to reap large benefits. Util izing information technology at the point of care and retrospectively to im prove decision making by all parties has the real potential to improve pati ent outcomes. Implementation of what at a local level? And what do we mean when local lev el is referred to? This article addresses these two questions and provides a framework for the engagement of patients, physicians, and members of the health care delivery team and organizations, at both the local and national levels, in improving patient outcomes. All have their roles, rights, and r esponsibilities. We are challenged to provide the right treatment, to the r ight patient, at the right time. End importantly, to provide the right info rmation, to the right person, at the right time.