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Translating Practice Guidelines Into Patient Care^*

Guidelines at the Bedside

^* From Health Services Research, Cedars-Sinai Health System, UCLA School of Medicine, Los Angeles, CA.

Correspondence to: Scott Weingarten, MD, MPH, Cedars-Sinai Health System Zynx Health, 9100 Wilshire Blvd, Suite 655, Beverly Hills, CA 90212; e-mail: weingarten{at}csmc.edu

Practice guidelines have been developed by a myriad of government, subspecialty, and local organizations in an attempt to reduce undesirable variations in care and to improve the quality of care. Despite the current enthusiasm driving the creation of thousands and thousands of guidelines, their longevity will depend on the ability to demonstrate measurable improvements in patient care caused by the dissemination and implementation of guidelines. In order for guidelines to improve care, they must influence the decisions that physicians and other health-care providers make as they care for patients on a day-to-day basis. Studies on this topic show that some guideline implementation strategies are consistently effective, meaning that they lead to changes in care that benefit patients. Other strategies have been shown to be consistently ineffective. Using an evidence-based approach to selecting guideline dissemination and implementation strategies may facilitate the greatest chance of success, and enhance the probability that patient care will be meaningfully improved as a result of these efforts.

Key Words: cost of care • practice guidelines • quality of care

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