Bench to trench: how evidence and guidelines shape health care policy and practice

Clinical practice guidelines and performance measures are becoming increasingly pervasive. They epitomize the evidence-based movement, which recognizes that mere "clinical judgment" is often inadequate to synthesize all the important data to determine the best management for a particular patient. This movement has at its core the fundamental expectation that medical decisions be based on sound data rather than anecdote. Unfortunately, this concept rarely manifests in daily practices where significant variations in care still exist. Guidelines were designed to improve patient care, reduce unnecessary variation, and reduce attributed costs. Therefore, it is not surprising that associated recommendations are now being incorporated into health care legislation as part of the Patient Protection and Affordable Care Act. In this environment, there is growing urgency for otolaryngologists to participate in rigorous comparative effectiveness research that will direct our Academy's guideline developers and policy makers to make recommendations that optimize care for all our patients.