Practice guidelines and outcomes. Where are we headed?

Major forces are at work within the health care system that drive the development of clinical standards or guidelines. This process must be tied in a "feedback-loop" system to a more accurate assessment of patient outcomes. There is a major controversy at the foundation of the process that is pitting the opinions from consensus panels of experts against the inability of individual physicians to accurately estimate the outcomes of different options through implicit systems. In many instances, the quality of medical evidence is poor. Many groups within organized medicine are attempting to write guidelines, and at least four major challenges must be confronted before guidelines are widely adopted by clinicians. A new federal agency may provide the necessary resources to focus the debate on guidelines. Guidelines may eventually enhance the quality of medical care.