Cognitive psychological studies of representation and use of clinical practice guidelines

Clinical practice guidelines provide a means to enhance physician performan ce. This investigation was undertaken in an attempt to understand the natur e of impact of guideline use on physician performance. We investigated the impact of (a) algorithmic-based and (b) text-based practice guidelines on c linical decision-making by physicians at varying levels of expertise. Data were collected using clinical scenarios and a think-aloud paradigm, both wi th (primed) and without (spontaneous) the use of the guidelines. The two gu idelines used in the study were management of diabetes and screening for th yroid disease. The results show that guidelines were used as reminders for both experts and non-experts. Guidelines acted as an educational tool for n on-experts by assisting in knowledge reorganization, particularly for the n on-experts. Text and algorithmic guideline formats were both useful to phys ician performance depending on the purpose of use: solving clinical problem s or learning. These results provide insights into how guidelines can be fi ne-tuned for different users and for different purposes. Empirical research , coupled with design principles from the cognitive sciences, can form an e ssential component of guideline design and development. (C) 2001 Elsevier S cience Ireland Ltd. All rights reserved.