Local implementation of clinical practice guidelines and continuous quality improvement: challenges and opportunities

Implementing clinical practice guidelines (CPGs), disease management programs, and quality improvement projects requires an understanding of the trends that will facilitate adoption at the local level. These trends include consumerism and the building of a national information technology infrastructure. The recommendations of the Presidential Advisory Commission on Consumer Protection and Quality in the Health Care Industry and the Institute of Medicine (IOM) report entitled "To Err Is Human: Building a Safer Health System" will frame developments and implementation. The relative roles and responsibilities of national entities, with coordination and integration of these activities with local efforts will need to be carefully orchestrated. Utilizing the Web to connect dialysis facilities, patients, and members of the health care delivery team has the potential to reap large benefits. Utilizing information technology at the point of care and retrospectively to improve decision making by all parties has the real potential to improve patient outcomes. Implementation of what at a local level? And what do we mean when local level is referred to? This article addresses these two questions and provides a framework for the engagement of patients, physicians, and members of the health care delivery team and organizations, at both the local and national levels, in improving patient outcomes. All have their roles, rights, and responsibilities. We are challenged to provide the right treatment, to the right patient, at the right time. And importantly, to provide the right information, to the right person, at the right time.