Why outcomes measurement must be the basis for the development of clinical guidelines

Three approaches to clinical quality improvement, health care standards, clinical guidelines, and quality improvement research, are differentiated by the quality of the available medical evidence linking health care processes to health care outcomes. The key determinant of Permanente Medical Group physician acceptance and use of a clinical guideline is the belief that solid data links the guideline's advice to improved patient outcomes. Purchasers, government agencies, regulatory organizations, and health plans must understand the difference between health care standards and clinical guidelines. Strict adherence to clinical guidelines should never be the basis for accountability for physicians, medical groups, or organized systems of care.