Algorithm based improvement of clinical quality.

Abstract

Ambulatory medical practice has traditionally taken place behind closed office doors. In recent years there has been a shift of important clinical decision making from the hospital setting to the physician's office, and ambulatory practices have been organised into managed entities (for example, health maintenance organisations and large group practices). Concomitantly, there has been an increasing interest in managing the practice that occurs behind the closed office door without violating the confidentiality of the physician-patient relationship. Problems relating to widespread variation in practices and practice styles have begun to surface, and the issue is not whether, but how best, to manage the variation. One approach, which is increasingly discussed, is to develop guidelines for practice. Though developing and disseminating guidelines undoubtedly will be increasingly important in managing clinical practices, guidelines are just the initial component of a cyclical process for improving clinical performance.