AMA Clinical Quality Improvement Forum ties it all together: from guidelines to measurement to analysis and back to...

In Chicago October 15, 1998, the American Medical Association (AMA) Department of Clinical Quality Improvement introduced a broadened scope for its Practice Parameters Forum, now retitled the Clinical Quality Improvement Forum. The Forum will now focus on integrating all the components of what the AMA has identified as the quality continuum-clinical practice guidelines, performance measurement, and process and outcomes analysis.

The address "The Quality Continuum" heralded the ushering in of a third stage known as "clinical integration," which will become medicine's "industrial revolution." Unexplained clinical variation remains the major roadblock to lowering costs, improving quality, and establishing accountability. But several tools, from guidelines to case management, will help us work through our industrial revolution and integrate clinically.

GUIDELINES AND EVIDENCE-BASED REPORTS: The international Cochrane Collaboration, through its Collaborative Review Groups and systematic reviews, and the Agency for Health Care Policy and Research, through its Evidence-Based Practice Centers and other programs, are providing the evidence for other groups to use in developing their own guidelines, performance measures, and other tools. But measuring the effectiveness of implementing clinical preventive services remains a difficult challenge.

CLINICAL PROCESS MEASUREMENT: Presentations on the relationship between guidelines and performance measures, translating guidelines into review criteria/process measures, reasons for non-compliance with guideline recommendations, patient-reported process measurement, and specific process measurement experiences together reflected federal, national medical specialty society, state medical society/peer review organization, and university/health plan perspectives.

CLINICAL OUTCOMES MEASUREMENT: If outcomes can be associated with specific processes of care, clinical practice guidelines can be refined. However, outcomes are dependent on factors outside physicians' behavior and control, such as patient compliance, comorbidities, and other risk factors, and consequently consideration of these variables is essential to appropriately interpreting the data.