Incorporating clinical guidelines through clinician decision-making

被引:4
|
作者
Falzer, Paul R. [1 ,2 ]
Moore, Brent A. [2 ]
Garman, D. Melissa [3 ]
机构
[1] VA Connecticut Healthcare Syst, Clin Epidemiol Res Ctr, West Haven, CT USA
[2] Yale Univ, Sch Med, Dept Psychiat, New Haven, CT USA
[3] SW Mental Hlth Syst, Connecticut Dept Mental Hlth & Addict Serv, Bridgeport, CT USA
关键词
D O I
10.1186/1748-5908-3-13
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: It is generally acknowledged that a disparity between knowledge and its implementation is adversely affecting quality of care. An example commonly cited is the failure of clinicians to follow clinical guidelines. A guiding assumption of this view is that adherence should be gauged by a standard of conformance. At least some guideline developers dispute this assumption and claim that their efforts are intended to inform and assist clinical practice, not to function as standards of performance. However, their ability to assist and inform will remain limited until an alternative to the conformance criterion is proposed that gauges how evidence-based guidelines are incorporated into clinical decisions. Methods: The proposed investigation has two specific aims to identify the processes that affect decisions about incorporating clinical guidelines, and then to develop ad test a strategy that promotes the utilization of evidence-based practices. This paper focuses on the first aim. It presents the rationale, introduces the clinical paradigm of treatment-resistant schizophrenia, and discusses an exemplar of clinician non-conformance to a clinical guideline. A modification of the original study is proposed that targets psychiatric trainees and draws on a cognitively rich theory of decision-making to formulate hypotheses about how the guideline is incorporated into treatment decisions. Twenty volunteer subjects recruited from an accredited psychiatry training program will respond to sixty-four vignettes that represent a fully crossed 2 x 2 x 2 x 4 within-subjects design. The variables consist of criteria contained in the clinical guideline and other relevant factors. Subjects will also respond to a subset of eight vignettes that assesses their overall impression of the guideline. Generalization estimating equation models will be used to test the study's principal hypothesis and perform secondary analyses. Implications: The original design of phase two of the proposed investigation will be changed in recognition of newly published literature on the relative effectiveness of treatments for schizophrenia. It is suggested that this literature supports the notion that guidelines serve a valuable function as decision tools, and substantiates the importance of decision-making as the means by which general principles are incorporated into clinical practice.
引用
收藏
页数:12
相关论文
共 50 条
  • [1] Incorporating clinical guidelines through clinician decision-making
    Paul R Falzer
    Brent A Moore
    D Melissa Garman
    [J]. Implementation Science, 3
  • [2] Incorporating emotions into clinical decision-making solutions
    Zhang, Irene Y.
    Liao, Joshua M.
    [J]. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION, 2021, 9 (03):
  • [3] The process of clinical decision-making in transfusion medicine: Incorporating guidelines and algorithms into transfusion practices
    Goodnough, LT
    [J]. TRIGGER FACTORS IN TRANSFUSION MEDICINE, 1996, 31 : 35 - 45
  • [4] An Investigation of the Influence of Case and Clinician Gender in Clinical Decision-Making
    McCredie, Morgan N.
    Morey, Leslie C.
    [J]. PERSONALITY DISORDERS-THEORY RESEARCH AND TREATMENT, 2019, 10 (03) : 286 - 290
  • [5] Incorporating science into decision-making
    Karl, HA
    Turner, CE
    [J]. SCIENCE, 2003, 300 (5624) : 1370 - 1370
  • [6] Clinical Decision-making in Glioblastoma: The Influence of national Guidelines
    McLean, Aaron Lawson
    Senft, Christian
    Walter, Jan
    [J]. STRAHLENTHERAPIE UND ONKOLOGIE, 2023, 199 : S81 - S82
  • [7] Clinician Perspectives on Incorporating Patients' Values-Based Health Priorities in Decision-Making
    Ouellet, Gregory M.
    Kiwak, Eliza
    Costello, Darce M.
    Green, Ariel R.
    Geda, Mary
    Naik, Aanand D.
    Tinetti, Mary E.
    [J]. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2021, 69 (01) : 267 - 269
  • [8] REINTERPRETING INFORMED DECISION-MAKING THROUGH THE CLINICIAN-PATIENT RELATIONSHIP
    Campelia, Georgina D.
    Kirkpatrick, James N.
    [J]. ANNALS OF THORACIC SURGERY, 2019, 108 (06): : 1610 - 1611
  • [9] Incorporating Prognosis into Clinical Decision-Making for Older Adults with Diabetes
    Deardorff, W. James
    Covinsky, Kenneth
    [J]. JOURNAL OF GENERAL INTERNAL MEDICINE, 2023, 38 (13) : 2857 - 2859
  • [10] Incorporating patients' perceptions of their health into clinical decision-making processes`
    Andrade Machado, Rene
    [J]. JOURNAL OF NEUROSCIENCES IN RURAL PRACTICE, 2014, 5 : S5 - S6