Monday, May 2, 2011

Clinical Practice Guidelines: Not Just For Cancer Anymore

The lack of standardization of healthcare in the U.S. has led to shocking variations in treatment outcomes and equally shocking cost differentials, to the point that in some places, and for some conditions, more money is spent to deliver worse outcomes.

As a consequence, clinical practice guidelines will be developed and refined to achieve the goal of standardizing care across providers and geographies.

Oncologists are the Vanguard of the Guidelines-Centered Future

Only reluctantly do we give up our autonomy in this country, but oncologists -- for whom the stakes and challenges are especially high -- were early practitioners of evidence-based medicine and have already embraced clinical guidelines.

The National Comprehensive Cancer Network's (NCCN) Clinical Practice Guidelines in Oncology have become a staple resource to practicing oncologists. Insurers now look to the guidelines to help decide on coverage policies for cancer therapy. Patients motivated to search for online cancer information will find the NCCN Guidelines for Patients.

Clinical Practice Guidelines for Everything?

The move to optimize and standardize other areas of patient care gained momentum this past December when The Dartmouth Institute for Health Policy and Clinical Practice announced a collaborative initiative among seven premier U.S. healthcare organizations to share data on outcomes, quality, and costs.

The participants are: Dartmouth-Hitchcock, Cleveland Clinic, Denver Health, Geisinger Health System, Intermountain Healthcare, and the Mayo Clinic -- organizations which together manage 10 million patients. They'll be focusing first on a handful of conditions associated with rapidly increasing costs and wide variations in quality and outcomes across the country. Among them are asthma, diabetes, heart failure, and depression.

The collaborative aims to develop best-practice models that will, in their words, "impact the clinical care of patients across the country by disseminating these models quickly and working with providers and health systems to adapt them to local conditions."

Guidelines vs. the Free Market

This trend means that the battle for product success will increasingly be fought before a shrinking audience of decision-makers who control outcome studies and write the clinical treatment guidelines -- guidelines that will be followed by front-line providers and used by payors to set reimbursement policies. The masses of community practitioners who implement those guidelines will more faithfully follow clinical pathways they've had little role in creating.

There will, of course, always be some room for interpretation by site-of-care decision-makers because clinical situations can be ambiguous, and patient "portraits" not always crisp. But leverage with end-users will diminish as the role of brands is established earlier and elsewhere.

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