DMC Cardiovascular Institute, Detroit, MI, USA.
J Card Fail. 2010 Dec;16(12):915-8. doi: 10.1016/j.cardfail.2010.08.006.
Guidelines have rather quickly assumed a central role in health care delivery in the U.S. They have become the foundation on which performance measures are built and, therefore, a major player in assessing the quality of care provided by individuals and institutions, the ramifications of which involve reputation,reimbursement, and litigation. We are concerned, however, that in our enthusiasm for collectively endorsing these guidelines, we are marginalizing the importance of physician judgment and inadvertently risking the conversion of guidelines into "cookbooks." We believe that this editorial, while unequivocally acknowledging the fundamental importance of guidelines, simultaneously provides a critically important perspective on the potential for misuse of both guidelines and performance measures. Further, we hope that publication of this commentary will help temper enthusiasm for overzealous conversion of guidelines into performance measures, thereby restoring the vital role of physician judgment and insight into patient management.
指南在美国的医疗保健服务中已经迅速占据了核心地位。它们已成为构建绩效指标的基础，因此也是评估个人和机构所提供医疗质量的主要因素，其影响涉及声誉、报销和诉讼。然而，我们担心的是，在我们热衷于集体认可这些指南的同时，我们正在边缘化医生判断的重要性，并无意中使指南有可能转化为“食谱”。我们认为，这篇社论虽然明确承认指南的基本重要性，但同时也对指南和绩效指标的潜在误用提供了一个至关重要的视角。此外，我们希望发表这篇评论将有助于抑制将指南过于热情地转化为绩效指标的热情，从而恢复医生判断和对患者管理的洞察力的重要作用。
