Algorithm-based clinical quality improvement. Clinical guidelines and continuous quality improvement

Evidence documenting unexplained variation in clinical practices and outcomes has led to a proliferation of clinical practice guidelines in the hope that such efforts will lead to decreased variation, improved care, better outcomes, and lower costs. At Harvard Community Health Plan we have developed a clinical guideline development effort that focuses on the development of clinical algorithms and guidelines in a quality improvement model. The formal quality improvement process that we have described requires; (1) clear project definition and organization, (2) guideline development based on an understanding of patient needs, scientific evidence and clinical experience, (3) thorough analysis of potential problems with active implementation efforts, and (4) measurement and evaluation of results. By incorporating clinical guideline development into a quality improvement model and integrating such efforts with a total quality management strategy, we can substantially increase the likelihood of successfully implementing clinical practice guidelines and improving the quality of care that we deliver.