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Impact of changes in clinical practice guidelines on assessment of quality of care.

Publication ,  Journal Article
Lin, GA; Redberg, RF; Anderson, HV; Shaw, RE; Milford-Beland, S; Peterson, ED; Rao, SV; Werner, RM; Dudley, RA
Published in: Med Care
August 2010

BACKGROUND: Measures for pay-for-performance and public reporting programs may be based on clinical practice guidelines. The impact of guideline changes over time-and whether evolving clinical evidence can render measures based on prior guidelines misleading-is not known. OBJECTIVE: To assess the impact of using different percutaneous coronary intervention (PCI) guidelines when evaluating whether PCI was indicated. RESEARCH DESIGN: PCIs from the National Cardiovascular Data Registry's CathPCI registry performed in 2003-2004 were categorized into indication classes (Class I, IIa, IIb, III), using 2001 American College of Cardiology/American Heart Association guidelines for PCI, the guidelines available at the time of the procedures. The same procedures were recategorized using 2005 guidelines, which reflect the best evidence available to clinicians at the time of PCI. Procedures unable to be categorized were labeled as "Not Certain." SUBJECTS: Patients undergoing PCI for stable or unstable angina in 394 hospitals. MEASURES: Number of procedures changing classification categories using 2001 versus 2005 guidelines. RESULTS: A total of 345,779 PCIs were evaluated. Applying 2001 guidelines, 47.9% had Class I indications; 33.3% Class IIa; 5.9% Class IIb; 3.7% Class III; and 9.2% Not Certain. Applying 2005 guidelines to the same procedures, 25.1% had Class I indications; 57.5% Class IIa; 5.5% Class IIb; 3.7% Class III; and 8.3% Not Certain; 41.1% of procedures changed the classification overall. CONCLUSIONS: The changes in guidelines resulted in a marked shift in whether PCIs done in 2003-2004 were considered indicated. Guideline-based performance measures should be carefully evaluated before implementation to avoid incorrect assessments of quality of care.

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Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

August 2010

Volume

48

Issue

8

Start / End Page

733 / 738

Location

United States

Related Subject Headings

  • United States
  • Reproducibility of Results
  • Reimbursement, Incentive
  • Practice Guidelines as Topic
  • Patient Selection
  • Outcome and Process Assessment, Health Care
  • Humans
  • Health Policy & Services
  • Angioplasty, Balloon, Coronary
  • Algorithms
 

Citation

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ICMJE
MLA
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Lin, G. A., Redberg, R. F., Anderson, H. V., Shaw, R. E., Milford-Beland, S., Peterson, E. D., … Dudley, R. A. (2010). Impact of changes in clinical practice guidelines on assessment of quality of care. Med Care, 48(8), 733–738. https://doi.org/10.1097/MLR.0b013e3181e35b3a
Lin, Grace A., Rita F. Redberg, H Vernon Anderson, Richard E. Shaw, Sarah Milford-Beland, Eric D. Peterson, Sunil V. Rao, Rachel M. Werner, and R Adams Dudley. “Impact of changes in clinical practice guidelines on assessment of quality of care.Med Care 48, no. 8 (August 2010): 733–38. https://doi.org/10.1097/MLR.0b013e3181e35b3a.
Lin GA, Redberg RF, Anderson HV, Shaw RE, Milford-Beland S, Peterson ED, et al. Impact of changes in clinical practice guidelines on assessment of quality of care. Med Care. 2010 Aug;48(8):733–8.
Lin, Grace A., et al. “Impact of changes in clinical practice guidelines on assessment of quality of care.Med Care, vol. 48, no. 8, Aug. 2010, pp. 733–38. Pubmed, doi:10.1097/MLR.0b013e3181e35b3a.
Lin GA, Redberg RF, Anderson HV, Shaw RE, Milford-Beland S, Peterson ED, Rao SV, Werner RM, Dudley RA. Impact of changes in clinical practice guidelines on assessment of quality of care. Med Care. 2010 Aug;48(8):733–738.

Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

August 2010

Volume

48

Issue

8

Start / End Page

733 / 738

Location

United States

Related Subject Headings

  • United States
  • Reproducibility of Results
  • Reimbursement, Incentive
  • Practice Guidelines as Topic
  • Patient Selection
  • Outcome and Process Assessment, Health Care
  • Humans
  • Health Policy & Services
  • Angioplasty, Balloon, Coronary
  • Algorithms