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. "Practice guidelines should be followed in most cases, but deviations are common and can be justified based on individual or regional circumstances. In addition to clinical practice guidelines and protocols, many local practices have begun to create documents often called critical pathways. These documents, like clinical practice guidelines, outline the key events associated with managing a specific disease. However, unlike many practice guidelines, critical pathways are developed by caregivers from all disciplines who are involved with the patient and family, and they may include locally accepted practice in areas where a practice guideline might list only a series of unproved options. Critical pathways are used as tools to ensure 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 allow the local community to 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, "for two decades, payers and members of our government have wrestled with annual double-digit inflation in health care costs that has resisted regulation, utilization review, cost review, and the latest innovation or competition. a Second, several studies have documented inconsistencies in the rates at which high-cost ...