Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-27T21:42:50.179Z Has data issue: false hasContentIssue false
  • English
  • Français

Creating Practice Guidelines: The Dangers of Over-Reliance on Expert Judgment

Published online by Cambridge University Press:  01 January 2021

Robert L. Kane
Get access Rights & Permissions [Opens in a new window]

Extract

Discussions about the role of practice guidelines and the strength of the evidence on which they are based should begin with a set of more basic questions: What is the function of such guidelines and what forces shape their use?

At least two forces can be seen behind the press for guidelines. On the one hand, guidelines can be used to improve the quality of care by raising the general level of practice to meet at least the standards set by experts. At the other, they become vehicles for cost containment.

By international standards, the United States spends a disproportionate share of its gross domestic product on health care. The majority of spending increases are traceable to the growth in technology. Whether couched as a concern that resources could be better used to provide other parts of the population with more effective health care or as a general concern that money spent on health might be better used for other social goods, a notion exists that less is better.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 23 , Issue 1 , Spring 1995 , pp. 62 - 64
Copyright
Copyright © American Society of Law, Medicine and Ethics 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Callahan, D., Setting Limits: Medical Goals in an Aging Society (New York: Simon and Schuster, 1987).Google Scholar
Wennberg, J. Gittelsohn, A., “Variations in Medical Care among Small Areas,” Scientific American, 246 (1982): 120–35.CrossRefGoogle Scholar
Wennberg, J.E. Freeman, J.L. Culp, W.J., “Are Hospital Services Rationed in New Haven or Over-Utilized in Boston?,” Lancet, May 23 (1987): 1185–89.CrossRefGoogle Scholar
Wennberg, J.E., “Outcomes Research, Cost Containment, and the Fear of Health Care Rationing,” N. Engl. J. Med., 323 (1990): 1202–04.CrossRefGoogle Scholar
Institute of Medicine, Lohr, K.N., ed., Medicare: A Strategy for Quality Assurance (Washington, D.C.: National Academy Press, Vol. I, 1990), p. 441.Google Scholar
Leape, L.L. et al., “Does Inappropriate Use Explain Small-Area Variations in the Use of Health Care Services,” JAMA, 263 (1990): 669–72.CrossRefGoogle Scholar
Chassin, M.R. et al., “Does Inappropriate Use Explain Geographic Variations in the Use of Health Care Services? A Study of Three Procedures,” JAMA, 258 (1987): 2533–37; Brook, R.H. et al., “Predicting the Appropriate Use of Carotid Endarte-rectomy, Upper Gastrointestinal Endoscopy, and Coronary Angiography,” N. Engl. J. Med., 323 (1990): 1173-77; Winslow, C.M. et al., “The Appropriateness of Carotid Endarte-rectomy,” N. Engl. J. Med., 318 (1988): 721-27; and Winslow, C.M. et al., “The Appropriateness of Performing Coronary Artery By-Pass Surgery,” JAMA, 260 (1988): 505-09.CrossRefGoogle Scholar
Phelps, C., “The Methodologic Foundations of Studies of the Appropriateness of Medical Care,” N. Engl. J. Med., 329 (1993): 1241–45.CrossRefGoogle Scholar
Siegler, M., “Pascal's Wager and the Hanging of Crepe,” N. Engl. J. Med., 293 (1975): 853–57.CrossRefGoogle Scholar
Barry, M.J. Mulley, A.G.J. Fowler, F.J. Wennberg, J.W., “Watchful Waiting vs. Immediate Transurethral Resection for Symptomatic Prostatism: The Importance of Patients’ Preference,” JAMA, 259 (1988): 3010–17; Wennberg, J., “The Road to Guidelines,” HMQ, 2nd Quarter (1991): 2-7; and Kasper, J.F. Mulley, A.G. Wennberg, J.E., “Developing Shared Decision-Making Programs to Improve the Quality of Health Care,” Quality Review Bulletin, 18 (1992): 183-90.CrossRefGoogle Scholar