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Guidelines and Good Care

By May 5, 2011Commentary

Guidelines for care of particular conditions or diseases have assumed much greater importance in recent years as they have become the critical component of performance measurement programs, which themselves often have incentives and penalties for conformance or non-conformance with the guidelines.  Guidelines are supposedly evidence-driven, but the quality of the evidence is not always good.  Guidelines also are often simplified to make them easy to use and apply across the board, but patients are not so simple–they often present complex sets of circumstances.  A study published in the Annals of Internal Medicine looks at the benefits of making guidelines capable of taking these individual circumstances into consideration.   (Annals Article)

In a hypothetical study, the researchers compared results in a population eligible for blood pressure control treatment according to whether they received random care, care following the latest guidelines or care using those guidelines but adjusted for more individual factors, using a risk calculator.  They looked at whether fewer strokes or heart attacks would occur in any of these groups.  It should be kept in mind that this is a study of estimation, not a real randomized trial, but the results indicate that individualized care would prevent the same number of strokes and attacks at a lower cost, or would prevent more at the same cost.

Greater availability and sophistication of electronic medical records and clinical decision support systems should help physicians and other health professionals tailor care to individuals more effectively.  There is some added expense in doing this and it makes pay-for-performance programs more difficult to design and implement, but the critical goal of health care should always be better health outcomes, and individualized treatment is absolutely necessary to meet that objective.

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