How to structure clinical practice guidelines for continuous quality improvement?

E. Andrew Balas, Jerome Puryear, Joyce A. Mitchell, Bruce Barter

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


The purpose of this study was to evaluate the relevance of available practice guidelines to clinical quality improvement programs. A sample of 19 guidelines was evaluated in four prominent primary care areas. Two research assistants independently coded the clinical conditions and recommended/not recommended procedures abstracted from the guidelines (Cohen's kappa .67 and .50, respectively). An average of 35.1 (±25.8) medical conditions and 48.4 (±41.5) clinical procedures were defined by the guidelines. Most conditions were defined by using ICD-9-CM, age/sex group, or therapy, but 29% of definitions included symptoms which are not coded routinely. CPT codes alone were unable to identify most procedures. AHCPR guidelines mentioned significantly more procedures (p < .001) and fewer symptoms (p < .001) per clinical condition than other guidelines. The difficulty of finding codes for conditions and procedures, the high rate of non-codable items, and the lack of recommended measures limit the applicability of published clinical practice guidelines to continuous quality improvement programs.

Original languageEnglish (US)
Pages (from-to)289-297
Number of pages9
JournalJournal of Medical Systems
Issue number5
StatePublished - Oct 1994
Externally publishedYes

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Information Systems
  • Health Informatics
  • Health Information Management


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