A public/private partnership in the quest for quality: development of cerebrovascular disease practice guidelines and review criteria.

The development of Uniform Clinical Data Set (UCDS) algorithms for cerebrovascular disease can serve as a model for cooperation between government agencies and physician organizations in the development of clinical guidelines and the translation of practice guidelines into review criteria. UCDS is a computerized system of data collection and case finding developed by the Health Care Financing Administration (HCFA) to standardize the Peer Review Organization screening process for potential utilization and quality problems. Input on the cerebrovascular disease algorithms was provided through the American Medical Association UCDS Advisory Panel and the American Academy of Neurology Task Force on Hospital Utilization for Stroke. Physician organizations were successful in identifying problematic areas, improving the original algorithms, suggesting new issues for development, and deleting inappropriate or misdirected algorithms. Since HCFA modified the cerebrovascular disease algorithms in response to feedback, physician organizations have had an important impact on algorithm development. Unfortunately, the process for algorithm review was often complicated, inefficient, and slow. This process is reviewed, problems and constraints are discussed, and specific recommendations are given for improving the process.