A MODEL FOR PRACTICE GUIDELINE ADAPTATION AND IMPLEMENTATION - EMPOWERMENT OF THE PHYSICIAN

Background: Although the number of well-developed clinical practice guidelines is increasing rapidly, the successful implementation of practice guidelines on a large scale has not yet occurred. At the University of Michigan Medical Center, we model the process for implementation of practice guidelines and present the value added to clinical groups that undertake this process. Methods: Evaluation and selection of nationally developed clinical practice guidelines are based on prospectively determined criteria. Clinical champions are then recruited to lead teams in the adaptation of national guidelines to local circumstances and promote buy-in. Once optimal care has been defined by local clinicians, appropriateness of medical practice can be evaluated effectively; the definition of optimal care endorsed by local clinicians serves as the benchmark for analyzing medical practice decisions. implementation of guidelines occurs using leadership from clinical champions. Contracts and package prices that reflect optimal care can also be developed. Finally, this work can be disseminated throughout a health care delivery network. This activity will promote the delivery of optimal and comprehensive medical care throughout the region. Results: The Medical Center is now involved in eight separate practice guideline projects using this model. Conclusion: Important features of this model include 1) physician participation; 2) use of previously developed guidelines as a baseline (does not require development of practice guidelines de novo); 3) review of historical data after guideline endorsement to prevent biased definition of optimal care; 4) focus on appropriateness, not mechanics, of care; 5) a process that complements critical pathway development; 6) development of a package price that reflects value per unit service as well as strict cost competitiveness; and 7) a process to strengthen relationships with network partners.