Implementation of guidelines for prevention of deep vein thrombosis in a managed care environment

Implementation strategies are key factors in determining the overall success of clinical guidelines. They are important for changing physician practices and expected to result in clinical improvement or cost savings. Within an organization, the method of implementation should be a major component of the development of the guideline itself. In a group practice system, clinical guidelines must be clear and provide numeric thresholds or explicit criteria for decision points and subsequent action. Assessing the overall impact of a clinical practice guideline provides excellent feedback in determining whether goals are being met and provides guidance for fine-tuning strategic approaches. With regard to the prevention of deep vein thrombosis (DVT) monitoring, the overall results of a clinical practice guideline would assess guideline compliance, complications of the guideline interventions, as well as the incidence of DVT, pulmonary embolism, hospital readmissions, and mortality.