The Evolving Story of Guidelines and Health Care: Does Being NICE Help?
Authors: Pamela N. Peterson, John S. Rumsfeld
Journal: Annals of Internal Medicine (2011)

Editorials16 August 2011The Evolving Story of Guidelines and Health Care: Does Being NICE Help?Pamela N. Peterson, MD, MSPH and John S. Rumsfeld, MD, PhDPamela N. Peterson, MD, MSPHFrom Denver Health Medical Center, Denver, CO 80204, and Denver VA Medical Center, Denver, CO 80220. and John S. Rumsfeld, MD, PhDFrom Denver Health Medical Center, Denver, CO 80204, and Denver VA Medical Center, Denver, CO 80220.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-4-201108160-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical practice guidelines have a challenging role to play in the story of high-quality health care. Guidelines are central to the practice of evidence-based medicine, synthesizing evidence into care recommendations. They also fuel quality metrics, including performance measures, which are used for care accountability. Guidelines thereby serve a "dictionary" function for health care—a reference point for clinical decision making and performance improvement.Yet, tough questions about guidelines persist: Is there enough evidence for recommendations (1)? How prescriptive should they be? How should we apply recommendations to individual patients? And, given their wide availability over many years, why does health care ...References1. Tricoci P, Allen JM, Kramer JM, Califf RM, Smith SC. Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA. 2009;301:831-41. [PMID: 19244190] CrossrefMedlineGoogle Scholar2. Fonarow GC, Yancy CW, Hernandez AF, Peterson ED, Spertus JA, Heidenreich PA. Potential impact of optimal implementation of evidence-based heart failure therapies on mortality. Am Heart J. 2011;161:1024-1030. [PMID: 21641346] CrossrefMedlineGoogle Scholar3. Mant J, Al-Mohammad A, Swain S, Laramée P; for the Guideline Development Group. Management of chronic heart failure in adults: synopsis of the National Institute for Health and Clinical Excellence guideline. Ann Intern Med. 2011;155:252-9. LinkGoogle Scholar4. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al; American College of Cardiology Foundation. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol. 2009;53:1-e90. [PMID: 19358937] MedlineGoogle Scholar5. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Eur J Heart Fail. 2008;10:933-89. CrossrefMedlineGoogle Scholar6. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. In: Guyatt G, Rennie D, eds. Chicago: American Medical Assoc; 2002. Google Scholar7. Kent DM, Hayward RA. Limitations of applying summary results of clinical trials to individual patients: the need for risk stratification. JAMA. 2007;298:1209-12. [PMID: 17848656] CrossrefMedlineGoogle Scholar8. Owens DK. Improving practice guidelines with patient-specific recommendations [Editorial]. Ann Intern Med. 2011;154:638-9. [PMID: 21536940] LinkGoogle Scholar9. Kent DM, Shah ND. Personalizing evidence-based primary prevention with aspirin: individualized risks and patient preference [Editorial]. Circ Cardiovasc Qual Outcomes. 2011;4:260-2. [PMID: 21586722] CrossrefMedlineGoogle Scholar10. Gagliardi AR, Brouwers MC, Palda VA, Lemieux-Charles L, Grimshaw JM. How can we improve guideline use? A conceptual framework of implementability. Implement Sci. 2011;6:26. [PMID: 21426574] CrossrefMedlineGoogle Scholar11. Majumdar SR, McAlister FA, Furberg CD. From knowledge to practice in chronic cardiovascular disease: a long and winding road. J Am Coll Cardiol. 2004;43:1738-42. [PMID: 15145092] CrossrefMedlineGoogle Scholar12. Rumsfeld JS, Dehmer GJ, Brindis RG. The National Cardiovascular Data Registry: it's role in benchmarking and improving quality. US Cardiology. 2009;6:11-5. CrossrefGoogle Scholar13. Bufalino VJ, Masoudi FA, Stranne SK, Horton K, Albert NM, Beam C, et al; American Heart Association Advocacy Coordinating Committee. The American Heart Association's recommendations for expanding the applications of existing and future clinical registries: a policy statement from the American Heart Association. Circulation. 2011;123:2167-79. [PMID: 21482960] CrossrefMedlineGoogle Scholar14. Bradley EH, Nallamothu BK, Herrin J, Ting HH, Stern AF, Nembhard IM, et al. National efforts to improve door-to-balloon time results from the Door-to-Balloon Alliance. J Am Coll Cardiol. 2009;54:2423-9. [PMID: 20082933] CrossrefMedlineGoogle Scholar15. Ho PM, Tsai TT, Maddox TM, Powers JD, Carroll NM, Jackevicius C, et al. Delays in filling clopidogrel prescription after hospital discharge and adverse outcomes after drug-eluting stent implantation: implications for transitions of care. Circ Cardiovasc Qual Outcomes. 2010;3:261-6. [PMID: 20407117] CrossrefMedlineGoogle Scholar16. Porter ME. What is value in health care? N Engl J Med. 2010;363:2477-81. [PMID: 21142528] CrossrefMedlineGoogle Scholar17. Owens DK, Qaseem A, Chou R, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med. 2011;154:174-80. [PMID: 21282697] LinkGoogle Scholar18. James BC, Savitz LA. How intermountain trimmed health care costs through robust quality improvement Efforts. Health Aff (Millwood). 2011;30:1185-91. [PMID: 21596758] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Denver Health Medical Center, Denver, CO 80204, and Denver VA Medical Center, Denver, CO 80220.Disclaimer: The views expressed in this editorial are those of the authors and do not necessarily reflect those of the Department of Veterans Affairs, American College of Cardiology, or other entities.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1546.Corresponding Author: John S. Rumsfeld, MD, PhD, Denver VA Medical Center, Cardiology (111B), 1055 Clermont Street, Denver, CO 80220; e-mail, John.[email protected]gov.Current Author Addresses: Dr. Peterson: Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204.Dr. Rumsfeld: Denver VA Medical Center, Cardiology (111B), 1055 Clermont Street, Denver, CO 80220. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoManagement of Chronic Heart Failure in Adults: Synopsis of the National Institute for Health and Clinical Excellence Guideline Jonathan Mant , Abdallah Al-Mohammad , Sharon Swain , Philippe Laramée , and Metrics Cited ByPrevention of health care associated venous thromboembolism through implementing VTE prevention clinical practice guidelines in hospitalized medical patients: a systematic review and meta-analysisGuidelines Do Not Guide PracticeLes directives cliniques ne guident pas la pratiqueAssessment of the methodological quality of local clinical practice guidelines on the identification and management of gestational diabetesContemporary health care for Huntington diseaseWhy are clinical practice guidelines not followed?The Warwick Patient Experiences Framework: patient-based evidence in clinical guidelinesHeart failure guidelines: translation into clinical practice 16 August 2011Volume 155, Issue 4Page: 269-271KeywordsCaregiversClinical trialsDecision makingEchocardiographyEvidence based medicineHealth careHeart failureNatriuretic peptidesQuality improvementTreatment guidelines ePublished: 16 August 2011 Issue Published: 16 August 2011 CopyrightCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...