Implementing practice guidelines through clinical quality improvement.

The American health care delivery environment is changing. As provider-at-risk payment strategies become increasingly dominant, they will force health care providers to replace old strategies that measured and managed revenues with new strategies that measure and manage costs. Quality improvement (QI) theory provides a set of tools to do exactly that--to understand, measure, and manage health care delivery processes and their associated costs. As a methodology for process management, QI theory merges case management, practice guidelines, and outcomes research into a single coordinated effort. It appropriately redirects management focus to care delivery processes, rather than to physicians. It also defines and illustrates a set of principles by which health care administrators can constructively team with physicians to find and document the best patient care outcomes at the lowest necessary cost, using QI-based practice guidelines as a decision support and measurement tool.