When Clinical Practice Guidelines Collide: Finding a Way Forward

Abstract

Editorials7 November 2017When Clinical Practice Guidelines Collide: Finding a Way ForwardSheldon Greenfield, MD and Sherrie H. Kaplan, PhD, MPHSheldon Greenfield, MDHealth Policy Research Institute, Department of Medicine, University of California, Irvine, Irvine, California (S.G., S.H.K.)Search for more papers by this author and Sherrie H. Kaplan, PhD, MPHHealth Policy Research Institute, Department of Medicine, University of California, Irvine, Irvine, California (S.G., S.H.K.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2665 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail That physicians may disagree about appropriate care for an individual patient should come as no surprise. Diversity of physicians' backgrounds, training, and clinical practice experience is a well-documented contributor to physician-level variation in practice patterns. However, clinical practice guidelines (CPGs) are meant to reflect the best, most evidence-based care for the “average” patient and are meant to be followed by all physicians caring for those patients. Compensation in the United States will soon be adjusted on the basis of physician-level adherence to quality measures, which are often based on CPGs, and insurance coverage is increasingly based on CPG recommendations. Therefore, ...References1. Radhakrishnan A, Nowak SA, Parker AM, Visvanathan K, Pollack CE. Physician breast cancer screening recommendations following guideline changes: results of a national survey. JAMA Intern Med. 2017;177:877-8. [PMID: 28395005] doi:10.1001/jamainternmed.2017.0453 CrossrefMedlineGoogle Scholar2. Conlin PR, Colburn J, Aron D, Pries RM, Tschanz MP, Pogach L. Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline: management of type 2 diabetes mellitus. 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PLoS Biol. 2016;14:e2001221. [PMID: 28002462] doi:10.1371/journal.pbio.2001221 CrossrefMedlineGoogle Scholar7. Greenfield S. Clinical practice guidelines: expanded use and misuse [Editorial]. JAMA. 2017;317:594-5. [PMID: 28196236] doi:10.1001/jama.2016.19969 CrossrefMedlineGoogle Scholar8. Institute of Medicine. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Pr; 2011. Accessed at www.nap.edu/catalog/13058/clinical-practice-guidelines-we-can-trust on 19 December 2016. Google Scholar9. Sox HC. Conflict of interest in practice guidelines panels. JAMA. 2017;317:1739-40. [PMID: 28464160] doi:10.1001/jama.2017.2701 CrossrefMedlineGoogle Scholar10. Fineberg HV. Conflict of interest: why does it matter? JAMA. 2017;317:1717-8. [PMID: 28464149] doi:10.1001/jama.2017.1869 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Health Policy Research Institute, Department of Medicine, University of California, Irvine, Irvine, California (S.G., S.H.K.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2665.Corresponding Author: Sheldon Greenfield, MD, Health Policy Research Institute, Department of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA 92697.Current Author Addresses: Drs. Greenfield and Kaplan: Health Policy Research Institute, Department of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA 92697.This article was published at Annals.org on 24 October 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSynopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: Management of Type 2 Diabetes Mellitus Paul R. Conlin , Jeffrey Colburn , David Aron , Rose Mary Pries , Mark P. Tschanz , and Leonard Pogach Annals On Call - The Problem of Conflicting Guidelines Robert M. Centor and Terrence M. Shaneyfelt Metrics Cited byClinical Practice Guidelines on the Diagnosis and Management of Polycystic Ovary Syndrome: A Systematic Review and Quality Assessment StudyInclusion of Performance Parameters and Patient Context in the Clinical Practice Guidelines for Heart FailureGuidelines for hypertension management in primary care: is local adaptation possible?When Predictive Models CollideNotice to comply: A systematic review of clinician compliance with guidelines surrounding acute hospital-based infection managementA proposed framework for patient engagement throughout the broader research enterpriseFacts, interpretations, and valuesBarriers Associated With Evidence‐Based Practice Among Nurses in Low‐ and Middle‐Income Countries: A Systematic ReviewDevelopment of predictive risk models for major adverse cardiovascular events among patients with type 2 diabetes mellitus using health insurance claims dataClinical Practice Guidelines 7 November 2017Volume 167, Issue 9Page: 677-678KeywordsClinical geneticsClinical trialsConflicts of interestLife expectancyMammographyObservational studiesPatientsPrecision medicineTreatment guidelinesType 2 diabetes ePublished: 24 October 2017 Issue Published: 7 November 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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