Starbucks “has more error checks than the practice of medicine,” said Clancy, who was appointed Aug. 25 as the assistant deputy under secretary for health for quality, safety and value for the Veterans Affairs Department.
Early guidelines in the 1990s, Clancy said, were often hashed out over weekends by doctors sitting around a table in hotels near Chicago's O'Hare International Airport—and often without consulting the available evidence. The mindset at the time, she said, was: “Who needs evidence? I'm prominent in my field.”
Now, she said, national guidelines are subject to transparent and systematic reviews with drafts that are posted for public comment.
Researchers, she said, must reach out to the healthcare community at the very start of the process and ask: “What questions are we trying to answer?”
Clancy, who was chosen Modern Healthcare and Modern Physician's Most Influential Physician Executive in Healthcare in 2009, praised efforts such as the American College of Surgeons' National Surgical Quality Improvement Program that uses data from electronic patient registries to drive improvement.
“They collect information doctors think is important,” Clancy said, whereas other guidelines may be based on data from billing codes.
Another speaker, Dr. Mark Roberts, chairman of the University of Pittsburgh graduate school of public health's department of health policy and management, emphasized that these practice guidelines are not meant to replace clinical judgment, but are intended to put into common use practices with proven outcome benefits—such as giving hospitalized heart-attack patients an aspirin at discharge.
Before they are implemented or programmed into an electronic health-record alert, Roberts said, guideline developers have to demonstrate the need in order to win physician buy-in.
He added that there is a theory that guidelines or mandated practices could fade out as quality improves.
“As we get better and better and better at treating patients appropriately, we'll have to do less and less of that,” Roberts said. “I don't know if that's true, but I'd like to believe that.”
Follow Andis Robeznieks on Twitter: @MHARobeznieks
