Hayes O W
Michigan State University-College of Osteopathic Medicine, East Lansing 48824-1316.
J Am Osteopath Assoc. 1994 Sep;94(9):732-8.
The development of clinical practice guidelines has spread from utilization review agencies to physician specialty societies, federal agencies, managed care organizations, and academic health centers as their usefulness in accomplishing the goals of healthcare reform become clear. The author reviews the mounting evidence that variation in the practice of medicine suggests that patients in some areas are not receiving all needed services, while others are receiving unnecessary services. He explores the implications of practice guidelines for improving the quality of care while controlling cost. Practice guidelines are defined and distinguished from medical review criteria. The author explores the challenges in governance, funding, and guideline development and communication that will have to be overcome to establish the credibility of practice guidelines. Finally, he addresses the opportunities for the osteopathic medical profession to establish its uniqueness in this setting.
随着临床实践指南在实现医疗改革目标方面的效用变得清晰，其制定已从利用审查机构扩展到医师专业协会、联邦机构、管理式医疗组织和学术健康中心。作者回顾了越来越多的证据，这些证据表明医学实践中的差异意味着一些地区的患者没有得到所有必要的服务，而另一些患者却接受了不必要的服务。他探讨了实践指南在控制成本的同时提高医疗质量方面的意义。对实践指南进行了定义，并将其与医学审查标准区分开来。作者探讨了在治理、资金以及指南制定与传播方面必须克服的挑战，以确立实践指南的可信度。最后，他阐述了整骨医学专业在这种背景下确立其独特性的机遇。
