Strategies to Improve Clinical Practice Through Guidelines: Experience from Recent Studies Michael Cabana (UCSF) Rebecca Beyth (University of Florida) Kathy Berra (Stanford University) Thomas Bailey (Washington University) Benjamin Crabtree (Robert Wood Johnson Medical School) Catarina Kiefe (University of Alabama at Birmingham) Funded by the National Heart, Lung and Blood Institute

Clinical Practice Guidelines (CPGs) Systematically developed statements to influence practitioner and patient decisions about appropriate health care for specific clinical circumstances. Potential impact: –Change physician behavior to promote appropriate use of interventions –Improve the outcomes of medical care –Reduce variation in medical care CPGs have limited effect despite efforts for several decades (e.g., JNC and ATP)

Initiative History NHLBI released an RFA in 2001 to fund “Trials Assessing Innovative Strategies to Improve Clinical Practice through Guideline Implementation in Heart, Lung, and Blood Diseases.” 8 projects funded in additional projects funded in 2003 Investigators have met several times to share ideas, discuss barriers and lessons learned. Initiative includes requirement for sharing approaches and disseminating tools and results.

Project Themes PIProject Theme BaileySecondary prevention for hospitalized patients with CHD and use of statins for patients hospitalized with DM and LDL > 100 BeythTreatment and management of thromboembolic disorders. CabanaManagement of pediatric asthma. CarterAdherence to the JNC7 BP guidelines and improvement in BP control. CloutierUtilization of disease management program for asthma. CrabtreeImproving clinician and staff interaction, information sharing and decision making to improve adherence to multiple guidelines. EatonOptimal screening and management of cholesterol according to ATPIII guidelines. GoffAdherence to ATPIII and JNC-7 in the ambulatory care setting. KiefeTreatment and 3 0 prevention of acute coronary syndromes RothschildAppropriateness of inpatient transfusions.

Bodenheimer T, et al. JAMA 2002; 288: Bodenheimer T, et al. JAMA 2002; 288:

Agenda Clinician behavior change Role of Informed, Empowered Patient and Family in Improving Clinical Practice through Guidelines Integrating Information Technology into clinical practice: Tools for clinical decision support and guideline implementation Organizational Change and Team Building Conclusions and Implications

Agenda Clinician behavior change Role of Informed, Empowered Patient and Family in Improving Clinical Practice through Guidelines Integrating Information Technology into clinical practice: Tools for clinical decision support and guideline implementation Organizational Change and Team Building Conclusions and Implications

Agenda Clinician behavior change Role of Informed, Empowered Patient and Family in Improving Clinical Practice through Guidelines Integrating Information Technology into clinical practice: Tools for clinical decision support and guideline implementation Organizational Change and Team Building Conclusions and Implications

Agenda Clinician behavior change Role of Informed, Empowered Patient and Family in Improving Clinical Practice through Guidelines Integrating Information Technology into clinical practice: Tools for clinical decision support and guideline implementation Organizational Change and Team Building Conclusions and Implications

Agenda Clinician behavior change Role of Informed, Empowered Patient and Family in Improving Clinical Practice through Guidelines Integrating Information Technology into clinical practice: Tools for clinical decision support and guideline implementation Organizational Change and Team Building Conclusions and Implications