Clinical practice guidelines have been available to clinicians for
almost two 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 promote their adoption. Some of these
mechanisms include provision of individual physician report cards,
financial incentives, and various documentation 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 selected interventions designed to enhance guideline
compliance. Most of these challenges relate to reliability and
validity concerns regarding the three primary data sources used in
the evaluation process: medical records, administrative claims data,
and member survey data. Some of the interventions the health plan
has implemented to address these measurement challenges include using
hybrid methods of data collection and developing collaborative
partnerships with outside organizations to enhance the accuracy and
completeness of the available data. Outcomes of these efforts are
described, as are physician response and recommendations for future
enhancement of practice guidelines.