Evolution of "The Guideline Advantage": Lessons Learned From the Front Lines of Outpatient Performance Measurement

Heart disease, cancer, stroke, and diabetes mellitus collectively account for >1.37 million U. S. deaths each year (1). Compounding the tragedy is the knowledge that many of those deaths could be avoided through better application of clinical guidelines related to primary and secondary prevention or disease management. The combined control of blood pressure, lipids, and glucose has been shown to substantially reduce mortality and cardiovascular events (2,3). Screening for colon, cervical, breast, and lung cancer has been proven to reduce age-adjusted mortality from these diseases (4). In recognition of the common risk factors across these disease areas, the chief executive officers of the American Cancer Society, American Diabetes Association, and American Heart Association formed the Preventive Health Partnership in 2004. The 3 organizations have been working closely ever since to increase public awareness about healthy lifestyles, support policies that increase funding for and access to prevention programs and research, and increase the focus on prevention among healthcare providers. The American Cancer Society, American Diabetes Association, and American Heart Association have long developed scientific statements and evidence-based guidelines that promote public health services and clinical interventions of known efficacy for improving patient outcomes. Thus, maximizing adherence to quality-of-care guidelines is a high priority for each organization, because this will save lives and improve quality of life. This common purpose has served as a focal point for much of the collaborative work undertaken by the 3 organizations, including The Guideline Advantage (TGA). Launched in 2011, TGA is a jointly operated program designed to promote consistent use of evidence-based practice guidelines through existing healthcare technology in the outpatient setting. The ultimate goal of this undertaking is to improve patient care through quality improvement programs that provide feedback to clinicians and their practices on performance across various quality measures. The data gathered through TGA will provide a platform for longitudinal research on the impact of preventive care while also allowing practices to compare themselves to others across the country through benchmarking capabilities. The program's research strategy is focused on identifying patient-, provider-, and practice-level factors associated with guideline adherence and assessing the effectiveness of quality improvement interventions in increasing guideline adherence. The program's recognition component will publicly acknowledge achievements in providing consistent guidelines-based care. The present report reviews the origins and intent of TGA, explores recent changes in the health information technology landscape, and provides a set of key recommendations for outpatient performance measurement programs.