Effective Dissemination of Clinical Guidelines: Lessons Learned from a Structured Review of Appropriateness Criteria and Their Application to Clinical Cases. Executive Summary and Final Report

摘要

The Structured Criteria and Case Review (SCCR) Forum (the Forum) was a dissemination demonstration project using appropriateness criteria developed for four surgical procedures: (1) coronary artery by-pass graft, (2) carotid endarterectomy, (3) abdominal aortic aneurysm surgery, and (4) cataract extraction. The goal of this project was to increase our knowledge about how physicians can be encouraged to use the criteria to improve their medical practice. The objectives of the Forum were to involve physicians who perform the procedures in the systematic review of the criteria and to expand our understanding of communication, dissemination, and implementation issues for the appropriateness criteria considered for this project and for practice guidelines more generally. Thirty physicians from member academic medical centers attended a two-day meeting to review and discuss the criteria. Data were collected to document physicians' views about practice guidelines, previous involvement with guidelines development efforts, reaction to the appropriateness criteria and plans to share the criteria. The structured review included identifying criteria modifications at several stages. The project report summarizes physicians' reactions to the appropriateness criteria, the modifications proposed during the Forum, and the implications for guidelines dissemination. A set of recommendations is offered to guide future guidelines development and dissemination efforts.