Assuntos
Prática de Grupo/organização & administração , Serviços Preventivos de Saúde/organização & administração , Neoplasias da Mama/prevenção & controle , Prática de Grupo/normas , Humanos , Programas de Imunização/organização & administração , Masculino , Programas de Rastreamento , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Serviços Preventivos de Saúde/normas , Neoplasias da Próstata/prevenção & controle , Fumar , WashingtonRESUMO
A large nonprofit staff model Health Maintenance Organization experienced increased use of prostate specific antigen (PSA) as a screening test for prostate cancer beginning in May 1991. A critical evaluation of the evidence in support of PSA screening was done and concluded that the use of PSA to screen for prostate cancer did not meet the criteria for an effective screening program. A guideline stating that PSA was not recommended as a screening test was implemented focusing on a model of shared decision making. PSA test ordering decreased significantly when patients were fully informed about the evidence for PSA screening. If PSA screening had continued at the peak rate, the cascade of intervention initiated by screening would have resulted in significant complications and approximately $4,800,000 in increased costs.
Assuntos
Sistemas Pré-Pagos de Saúde , Programas de Rastreamento , Antígeno Prostático Específico , Neoplasias da Próstata/prevenção & controle , Humanos , Masculino , Programas de Rastreamento/economia , Neoplasias da Próstata/terapia , WashingtonRESUMO
Clinical practice guidelines can improve health care outcomes, but they are only as effective as their implementation. We present a framework for implementing practice guidelines that begins by identifying the forces driving and restraining the adoption of the guideline. Strategies for changing physician behavior that strengthen the driving forces and weaken the restraining forces can then be incorporated into a comprehensive implementation program. Nine strategies for changing physician behavior are presented, based on a review of the literature and organizational experience at Group Health Cooperative of Puget Sound. In designing an implementation strategy, it is essential that the resources allocated to implementation are commensurate with the improvement in outcomes expected from the successful implementation of the guideline. All implementation programs should include plans for measuring outcomes to allow for continuing improvement. Guideline implementation, evaluation and improvement efforts are most likely to be successful when they are part of an explicit, evidence-based process for evaluating and improving clinical practice.
Assuntos
Sistemas Pré-Pagos de Saúde/normas , Corpo Clínico/normas , Guias de Prática Clínica como Assunto , Tomada de Decisões , Humanos , Corpo Clínico/educação , Corpo Clínico/psicologia , Inovação Organizacional , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Técnicas de Planejamento , Padrões de Prática Médica , Desenvolvimento de Programas/métodos , Washington , Recursos HumanosRESUMO
Group Health Cooperative of Puget Sound has developed a model for evaluating and improving clinical practice based on an explicit, evidence-based approach. It is designed to identify gaps between current and optimal practices, and to bring about changes in physician behavior so that health care outcomes (health status, patient satisfaction, provider satisfaction, cost/utilization) are maximized. This model stresses the importance of a rigorous process in looking objectively at evidence in working to improve outcomes. Discrete tools have been developed which help teams move successfully from problem identification to the ongoing evaluation and improvement of a new clinical practice.
