The clinical guideline process within a managed care organization

Clinical practice guidelines have been available to clinicians for almost t wo decades, but the consistency of their implementation in practice remains highly variable. This paper describes the various processes and mechanisms used by one managed care organization to develop clinical guidelines and p romote their adoption. Some of these mechanisms include provision of indivi dual physician report cards, financial incentives, and various documentatio n tools that serve as reminders of guideline recommendations and provide an easy format to document recommended services. There have been measurement challenges in evaluating the effectiveness of s elected interventions designed to enhance guideline compliance. Most of the se challenges relate to reliability and validity concerns regarding the thr ee primary data sources used in the evaluation process: medical records, ad ministrative claims data, and member survey data. Some of the interventions the health plan has implemented to address these measurement challenges in clude using hybrid methods of data collection and developing collaborative partnerships with outside organizations to enhance the accuracy and complet eness of the available data. Outcomes of these efforts are described, as ar e physician response and recommendations for future enhancement of practice guidelines.