Improving Practice Guidelines With Patient-Specific Recommendations
Authors: Douglas K. Owens
Journal: Annals of Internal Medicine (2011)

Editorials3 May 2011Improving Practice Guidelines With Patient-Specific RecommendationsDouglas K. Owens, MD, MSDouglas K. Owens, MD, MSFrom Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-9-201105030-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical practice guidelines aim to help providers make decisions that optimize patient care (1). Both developers and users of guidelines understand that guidelines could be improved by tailoring the recommendations to the specific circumstances of an individual patient. Tailored guideline recommendations may improve health outcomes when a group of patients can be divided into subgroups in which the tailored recommendations would increase benefits, reduce harms, or save costs relative to more generic recommendations. For example, a guideline for hypertension may recommend antihypertensive treatment in patients whose blood pressure is higher than 140/90 mm Hg. However, patients with diabetes or high ...References1. Institute of Medicine. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Pr; 2011. Google Scholar2. Eddy DM, Adler J, Patterson B, Lucas D, Smith KA, Morris M. Individualized guidelines: the potential for increasing quality and reducing costs. Ann Intern Med. 2011;154:627-34. LinkGoogle Scholar3. Owens DK, Nease RF. A normative analytic framework for development of practice guidelines for specific clinical populations. Med Decis Making. 1997;17:409-26. [PMID: 9343799] CrossrefMedlineGoogle Scholar4. Nease RF, Owens DK. A method for estimating the cost-effectiveness of incorporating patient preferences into practice guidelines. Med Decis Making. 1994;14:382-92. [PMID: 7808213] CrossrefMedlineGoogle Scholar5. Sanders GD, Nease RF, Owens DK. Design and pilot evaluation of a system to develop computer-based site-specific practice guidelines from decision models. Med Decis Making. 2000;20:145-59. [PMID: 10772353] CrossrefMedlineGoogle Scholar6. Institute of Medicine. Initial National Priorities for Comparative Effectiveness Research. Washington, DC: National Academies Pr; 2009. Google Scholar7. Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J, Brooks MM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet. 2009;373:1190-7. [PMID: 19303634] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.Disclaimer: The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.Acknowledgment: The author thanks Alan M. Garber, MD, PhD, and Sara H. Cody, MD, for their comments and suggestions.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0687.Corresponding Author: Douglas K. Owens, MD, MS, Center for Primary Care and Outcomes Research, Stanford University, 117 Encina Commons, Stanford, CA 4305-6019; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIndividualized Guidelines: The Potential for Increasing Quality and Reducing Costs David M. 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Taichman, MD, PhD, Executive Deputy Editor, and Cynthia Mulrow, MD, MSc, Senior Deputy Editor 3 May 2011Volume 154, Issue 9Page: 638-639KeywordsBlood pressureCholesterolComparative effectiveness researchHypertensionMyocardial infarctionPatientsSimulation and modelingStable coronary artery diseaseSystolic pressureTreatment guidelines ePublished: 3 May 2011 Issue Published: 3 May 2011 PDF DownloadLoading ...