CPGs: Think Core Concept

In their paper on the promises and pitfalls of evidence-basedmedicine (Jan/Feb 05), Stefan Timmermans and Aaron Mauck citea number of barriers that hinder physicians from adhering toclinical practice guidelines (CPGs). We offer one more: Thereis little understanding of how CPGs can help physicians in theirdaily work. In a practice environment where the payment systemsbear no relationship to science or quality, day-to-day workis complicated by potential auditor requirements to documentpatient care, receive prior authorization of services by healthplans, and manage prescription needs to plan-specific formularies.Physicians often see CPGs as simply adding to an intolerableadministrative burden.

We have posited, however, that if CPGs were made the bedrockfor physician practice—driving wide-ranging administrativesystems including documentation, workforce planning, capitalequipment purchases, and, most important, the payment systemand not just care processes—the value of CPGs would bebetter appreciated, and they would be more widespread.¹ We haveproposed five principles to address these issues. With CPGsas the foundation for both clinical and administrative systems,standardization to the science would save physicians substantialamounts of time and free them to custom-craft the art of carefor their patients.² This is a different view of what CPGs offerand makes a far better business case for quality than has existedto date.

Alice G. Gosfield and James L. Reinertsen

NOTES

A. Gosfield, "The Doctor-Patient Relationship as the Business Case for Quality: Doing Well by Doing Right," Journal of Health Law 37, no. 2 (2004): 197–223[Medline]; and J. Reinertsen and A. Gosfield, "Doing Well by Doing Good: Improving the Business Case for Quality," June 2003, www.uft-a.com/PDF/uft-a_White_Paper_060103.PDF (11 March 2005).
J. Reinertsen, "Zen and the Art of Physician Autonomy Maintenance," Annals of Internal Medicine 138, no. 12 (2003): 992–995.[Abstract/Free Full Text]

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CPGs: Think Core Concept