Dr Derek Raghavan Provides Best Practices for Implementing Guidelines

Physician involvement, patient input, and accuracy are the most important aspects of successfully implementing guidelines, said Derek Raghavan, MD, PhD, FACP, FRACP, president, Carolinas HealthCare System's Levine Cancer Institute.

What recommendations for implementing guidelines can physicians and administrators do to start the process off right?
The most important thing for getting guidelines implemented successfully is to ensure that the physicians involved in treatment are actually involved in the creation of guidelines. It doesn’t have to mean that every doctor has his say, but you have to have representation from the leaders of the medical profession, whether it’s in hematologic oncology or solid tumor oncology or even cardiology or hypertension. You have to have the leading doctors at the table, you have to have people who are in community practice who know the reality of being in small offices rather than large centers at the table, able to say, “You could do this in a center of excellence, but we simply can’t do it in an isolated center.” So, you have to have engagement of the medical community.

You need to have input from patients, so you know that what you’re designing is both affordable and acceptable to patient populations. And all of this has to be based on the best available data. If there isn’t good information available about how to do things optimally, then you need to define that your guidelines are less precise and give more leeway until the data are there. At the same time, we do need to incentivize the medical profession to understand that limiting variation is important. That many people who believe that individual judgement may overcall the benefits of that judgement; not to imply that experience or judgement are unimportant, but simply to say that, that experience needs to dovetail with the best evidence that’s published and the best studies that are there.

The other very important aspect of moving guidelines out into the community is to ensure that they are accurate; unfortunately, not all published guidelines are based on the best evidence, there are mistakes that are built in. So, there needs to be a mechanism to amend guidelines that have errors in them, and they have to be simply enough to allow implementation out in the clinical world.
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