Enhancing physicians' use of clinical guidelines

摘要

A dozen years ago, investigators identified adherence barriers to help guideline developers and other stakeholders design strategies to increase guideline use.1 Today, adherence to guidelines often remains low, causing omission of therapies recommended in the guidelines and contributing to preventable harm, suboptimal patient outcomes or experiences, or waste of resources. In part because of inadequate adherence to guidelines, preventable harm is the third leading cause of patient death, and one-third of health care spending— estimated at nearly $1 trillion, or $9000 per household—is for therapies that do not improve patients' health.2 One estimate suggests that each year, 200 000 patients die from sepsis, 120 000 from teamwork failures, 100 000 from health care-acquired infections, 100 000 from venous thromboembolism and pulmonary embolus, 80 000 from diagnostic errors, and 68 000 from decubitus ulcers.