Medical guideline
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A '''medical guideline''' (also called a '''clinical guideline''', '''clinical protocol''' or '''clinical practice guideline''') is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of [[healthcare]]. Such documents have been in use for thousands of years during the entire [[history of medicine]]. However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of [[evidence-based medicine]]. They usually include summarized [[consensus (medical)|consensus statements]], but unlike the latter, they also address practical issues.
Modern clinical guidelines briefly identify, summarize and evaluate the best evidence and most current data about [[preventive medicine|prevention]], [[diagnosis]], [[prognosis]], therapy including dosage of medications, [[risk-benefit analysis|risk/benefit]] and [[cost-effectiveness]]. Then they define the most important questions related to clinical practice and identify all possible [[medical decision making|decision options]] and their [[upside outcomes|outcomes]]. Some guidelines contain decision or computation [[algorithm (medical)|algorithms]] to be followed. Thus, they integrate the identified decision points and respective courses of action to the clinical judgment and experience of practitioners. Many guidelines place the treatment alternatives into classes to help providers in deciding which treatment to use.
Additional objectives of clinical guidelines are to [[standardization|standardize]] medical care, to raise quality of care, to reduce several kinds of risk (to the patient, to the healthcare provider, to [[medical insurance|medical insurers]] and health plans) and to achieve the best balance between cost and medical parameters such as [[effectiveness]], [[specificity (tests)|specificity]], [[sensitivity (tests)|sensitivity]], resolutiveness, etc. It has been demonstrated repeatedly that the use of guidelines by healthcare providers such as [[hospitals]] is an effective way of achieving the objectives listed above, although they are not the only ones.
Special [[computer software]] packages known as [[guideline execution engine]]s have been developed to facilitate the use of medical guidelines in concert with an [[electronic medical record]] system.
The ''Guideline Interchange Format (GLIF)'' is a computer representation format for clinical guidelines that can be used with such engines.<ref>[http://www.glif.org GLIF website]</ref>
It has been found<ref>[[Gina Kolata]] "[http://www.nytimes.com/2004/12/25/health/25medicine.html?ex=1104982386&ei=1&en=404dbf44fc67b089 Program Coaxes Hospitals to See Treatments Under Their Noses]". ''[[New York Times]]'' December 25, 2004.</ref> that some simple clinical practice guidelines are not routinely followed to the extent they might be. It has been found that providing a [[nurse]] or other medical assistant with a [[checklist]] of recommended procedures can result in the attending physician being reminded in a timely manner regarding procedures that might have been overlooked.
The guideline-based approach to healthcare is a relatively recent one and has originated in the United States in the 1990s. Guidelines are usually produced at national or international levels by medical associations or governmental bodies, such as the ''US Agency for Healthcare Research and Quality''. Local healthcare providers may produce their own set of guidelines or adapt them from existing top-level guidelines.
The USA and other countries maintain medical guideline [[clearinghouse]]s. In the USA, the [http://www.guideline.gov/ National Guideline Clearinghouse] maintains a catalog of high-quality guidelines published by various organizations (mostly professional physician organizations). In the United Kingdom, clinical practice guidelines are published primarily by the [[National Institute for Health and Clinical Excellence]] (NICE). In The Netherlands, two bodies (CBO and NHG) publish specialist and primary care guidelines, respectively. In Germany, the [[German Agency for Quality in Medicine]] (AEZQ) coordinates a national program for disease management guidelines. All these organisations are now members of the [[Guidelines International Network]], an international not-for-profit association of organisations and individuals involved in clinical practice guidelines. G-I-N is owner of the International Guideline Library - the largest web based data base of medical guidelines worldwide.
==See also==
* ''[[Treatment Guidelines from The Medical Letter]]''
* [[Medical decision making]]
* [[Evidence-based medicine]]
* [[Consensus (medical)]]
* [[Algorithm (medical)]]
* [[Clinical protocol]] ''(cf. first line of the present article)''
==References==
<references/>
==External links==
* [http://www.guideline.gov/ National Guideline Clearinghouse] (NGC), a public resource for evidence-based clinical practice guidelines. NGC is an initiative of the [[Agency for Healthcare Research and Quality]] (AHRQ), [[U.S. Department of Health and Human Services]]
* [http://www.cochrane.org/ The Cochrane Collaboration]
* [http://www.glif.org/ Guideline Interchange Format]. The [[Guideline Interchange Format]] (GLIF) is a specification for structured representation of guidelines.
* [http://gem.med.yale.edu/ Guideline Elements Model]. The Guideline Elements Model (GEM) is an ASTM standard for the representation of practice guidelines in XML format.
* [http://www.medicare.gov/Hospital/Home.asp?version=alternate&browser=IE%7C5%7CMacPPC&language=English&defaultstatus=1&pagelist=Home 2004 report] [[Hospital Quality Alliance]] (HQA), a project of the [[Hospital Quality Initiative]] (HQI) of the [[Centers for Medicare and Medicaid Services]] (CMS)
* [http://www.sign.ac.uk Scottish Intercollegiate Guidelines Network (SIGN)]. Contains 113 evidence-based clinical guidelines - published, in development, or under review.
[[Category:Medical literature]]
[[Category:Medical informatics]]
[[Category:Medical terms]]
[[Category:Healthcare quality]]
[[Category:Medical guidelines]]
[[de:Nationale Versorgungsleitlinie]]