Healthcare Practice Guidelines

Conceptual Overview and Discussion

Historically, in the Western world, healthcare practice was an individual skill learned at an accredited school of medicine, nursing, etcetera. Providers were educated, examined, and licensed and then expected to apply their knowledge and skills independently to the assessment and treatment of patients' illnesses or injuries. However, in an effort to codify and normalize the treatment and decision-making process, healthcare practice guidelines began to be developed in the latter half of the 20th century.

The concept for creating clinical practice guidelines derives from the need to disseminate the latest clinical information to healthcare providers and improve the quality of care by:

• Standardizing treatment decisions
• Delivering the best outcomes possible
• Maximizing patient safety
• Enhancing cost effectiveness

To accomplish these goals, healthcare practice guidelines rely on analyses of published case studies and other data as the sources for evidence-based medicine. The theory of evidence-based medicine was first postulated by researchers from McMaster's University in the early 1990s. Evidence-based medicine evolved from an effort to refocus clinical decision making and treatment from a subjective undertaking by individual providers to a standardized practice based on published research, clinical data, and technological advances. By utilizing a combination of widely accepted experiential and clinical research evidence related to diseases, injuries, and treatments, healthcare practice guidelines were developed for a wide variety of diagnoses and conditions.

Over the past three decades the creation of healthcare practice guidelines has exploded. According to the U.S. Agency for Healthcare Research and Quality (AHRQ) Web site, in 2008 there were more than 2,300 different healthcare practice guidelines. These guidelines describe the [Page 434]diagnosis, treatment, and care for patients with diseases ranging from hypertension to malignant bone cancer and from chest trauma to acute cardiovascular accidents. However, the complexity and diversity of the vast number of guidelines being developed throughout the world does not mitigate the fact that critics remain concerned that the proliferation of guidelines will standardize health practices to such an extent that the quality of care will suffer. In addition, while research has shown that use of healthcare practice guidelines does effectively change some providers' behaviors, decision making, and outcomes—many providers do not adhere to them.

The rejection of healthcare practice guidelines has been explained by George Weisz and others as a reaction to the perception that guidelines resulted from politicians' and administrators' desire to control economic rather than healthcare issues. Furthermore, many providers have argued that the use of healthcare practice guidelines reduces their professional autonomy. However, it has also been postulated that the increasing emphasis on clinical practice guidelines results from the sociological imposition of outside forces, by nonproviders, on healthcare decision making and practice. With these varied concerns impacting acceptance and utilization of healthcare practice guidelines, researchers have suggested using theoretical frameworks to enhance provider adoption.

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