gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Evidence and Recommendations to Support Improvement in Key Clinical Areas

Meeting Abstract

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  • J. Harris - The Permanente Medical Group, San Rafael, CA, USA
  • A. Whippy - The Permanente Medical Group, Oakland, CA, USA

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocO47

doi: 10.3205/12gin079, urn:nbn:de:0183-12gin0790

Published: July 10, 2012

© 2012 Harris et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Consistent adherence to evidence-based best practices should significantly improve health. However, systematic reviews and guidelines have covered different clinical questions, omitted some key topics, and used different methodologies, creating some confusion and redundant effort.

Objectives: 1. To compare systematic reviews and guideline recommendations for acute coronary syndrome, congestive heart failure, stroke, sepsis and hospital-acquired infections; 2. To describe efforts and outcomes implementing best practices consistently in a large health care system using available recommendations.

Methods: We searched the Cochrane Library and other major data bases for systematic reviews and guidelines on the above topics. We compared the methodologies used, evidence syntheses and guideline recommendations. We also reviewed relevant process improvement (PI) methods and projects at Kaiser Permanente.

Results: Methodologies varied among SRs and guidelines, yet recommendations converged. There was good evidence for some tests and treatments, but less so for the entire integrated process. Nevertheless, positive results were demonstrated in most areas.

Discussion: Trials generally focus on specific tests or treatments rather than processes of care. Evidence to support health care processes may require chains of evidence, which are indirect by definition. Outcomes of processes of care include positive or adverse events, resource use, and operational efficiency as well as intermediate and final clinical states.

Implications for guideline developers/users: Consistency of methods would allow confident sharing of methods and guidelines, reducing resource and time use. Even when there is good evidence, how to have providers to do the right thing consistently remains a challenge.