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December 17, 1997

Translating Good Advice Into Better Practice

Author Affiliations

From Partners Community HealthCare, Inc (Drs Lee and Cooper), Brigham and Women's Hospital (Dr Lee), North Shore Health System (Dr Cooper), and Harvard Medical School (Dr Lee), Boston, Mass.

JAMA. 1997;278(23):2108-2109. doi:10.1001/jama.1997.03550230084043

The filing cabinets of physicians today are bulging with practice guidelines that have been derived from different organizations for various purposes. Some of these guidelines attempt to define appropriate and inappropriate care, while others seek to standardize how medical tasks are performed. These latter guidelines often take the form of "critical paths"1 that set ambitious goals for length of stay or clinical processes, such as time to treatment with thrombolytic therapy.2

See also p 2075.

Regardless of their nature, the true goal of guidelines should be to improve care—meaning better patient outcomes or increased efficiency, or both. Unfortunately, our strong suspicion is that most guidelines that reach physicians' filing cabinets remain there. Only a handful of guidelines have been shown to have a beneficial impact on patient care,3 and research evaluating the impact of guidelines has shown decidedly mixed results.5-7

Few physicians would challenge the credibility