ne, and clinical protocols. To clarify guideline development, one differentiation that is made between the different names for standards is that practice guidelines are intended to be more flexible than protocols or standards·documents that recommend practice patterns that are based on observed outcomes and that result in uniformly accepted health and economic consequences. Generally, an accepted premise is that practice guidelines should be followed in most cases, but that unique situations cause justifiable deviations from guidelines to be common. As supplements to clinical practice guidelines and protocols, many local practices now create documents often called critical pathways. These documents, as is true of clinical practice guidelines, outline the key events associated with managing a specific disease. Unlike many practice guidelines, however, critical pathways are developed by caregivers from all disciplines who are involved with patients and their families. Critical pathways, thus, may include locally accepted practice in areas where a practice guideline might list only a series of "unproved options." Critical pathways are used to assure that key events in the management of a patient occur at specific times in the course of the illness. Deviations from the critical pathway that result in a better or worse observable outcome for the patient identify areas for performance improvement.
Why Medical Practice Guidelines Are Developed
Researchers, professional societies, health care institutions, and public agencies have taken the lead in developing practice guidelines. Two major factors have played a role in this development. First, the problem of continually escalating health care costs has persisted in the face of massive efforts to control or manage costs. Second, inconsistencies·regionally, institutionally, and in other contexts·exist in the rates at which high-cost procedures are performed. An assumpti...