Evidence-based clinical guidelines: Good for medical care?

Guidelines rely on the probabilities of an event given a specific situation. In medicine, guidelines are developed based on predictable patterns. Doctors and other healthcare providers can use guidelines to improve medical treatment. If guidelines are proven to improve quality, why isn’t their use required?

In April 2012, nine medical societies, as part of an initiative called “Choosing Wisely,” announced a list of commonly used tests and treatments that should be avoided. These professional societies publicly support the use of evidence-based medical practice.

At CareCore, we partner with medical experts such as national leaders in cardiology, cancer experts at the University of Pittsburgh Medical Center, laboratory experts at the University of Washington, and orthopedics experts at the OrthoCarolina Research Institute. Together, we use specialty society guidelines, published peer-reviewed articles and expert opinion to develop the evidence-based guidelines. These are then transformed into care pathways that can be applied at the point of care through an EMR, or a handheld device.   

Projections from the Congressional Budget Office indicate that up to 30 percent of care delivered in the United States goes toward medical services that may be unnecessary or harmful.  For example, all tests can sometimes give falsely positive results. These false results can then lead to treatments that can cause harm. The Centers for Disease Control (CDC) recommends that before ordering a lab test, doctors should consider how likely it is that the patient has the disease. The US Preventive Service Task Force just released a guideline suggesting that using a commonly used “screening” test for prostate cancer, PSA, causes more harm than good. Some estimate that more than 50% of positive tests are false positives.  False positives are a problem for genetic testing as it is for more routine lab tests. Would you want a guideline to be used to help decide which tests you should have?  Of course you would.

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