From clinical guidelines to quality assurance: The experience of assistance Publique-Hopitaux de Paris

Content: The objective of the AP-HP program is to promote the appropriate use of clinical guidelines and to evaluate their impact on quality of care and/or costs, Experiments such as controlled trials are used to test the effectiveness of some implementation strategies, to verify that guidelines do improve the process of care and to improve physician compliance with clinical guidelines, Guidelines are developed in a context of budget constraint, and the general aim of the program is to promote the more efficient use of available health resources, Results: In a context of health care inflation, the desire of public authorities is to use guidelines as a tool for cost control strategy, either for ambulatory care or for hospitals, AP-HP experience shows that it is very difficult to develop a national program of clinical guidelines and to implement it in every hospital, as was done in France (but not clearly evaluated) in ambulatory care (under the name 'references medicales'). Guidelines need to be locally adapted, and the best implementation strategies depend on local resources, for example the existence of a pertinent information system, The role of financial incentives is present in French policies, and the role of the drug industry needs to be evaluated, (C) 1997 Elsevier Science Ltd.