Medical Standards of Care and Clinical Practice Guidelines

If you want to research the clinical practice guidelines for a disease, condition, treatment or intervention or for health services administration, you can browse them online here. Your prescription in determining the standards of care and clinical guidelines applicable to your cases. Medical standards of care and clinical practice guidelines are established by a consensus of health care professionals as diagnostic and therapeutic actions or behaviors that are considered the most favorable in affecting the patient’s health outcome. The Internet offers a wide variety of expert consensus and evidence-based standards and guidelines, which provide insight, on a national level, to a broad scope of medical practice. Additionally, standards of care are established through, state and federal regulations, institutional policy & procedures, expert witnesses and literature. These links will lead directly to the pertinent sections on standards, guidelines, or position statements.

A medical guideline also called a clinical guideline or clinical practice line is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine. However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine. They usually include summarized consensus statements on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of his or her profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment.

Prescriptive standards of clinical conduct practice guidelines have proliferated throughout medicine over the past decade. Practicing physicians are confronted with a plethora of guidelines developed for different purposes by a diverse body of public and private organizations. We review factors contributing to the growth of guidelines, their desirable features, and consequences, legal and otherwise, of implementing guidelines. Few studies have examined whether, and under what conditions, guidelines are effective in changing physicians practices and patients health. Nonetheless, expectations for guidelines remain high because they are one of the only instruments of health care reform that promises to improve the quality of care while reducing overall health care costs. Efforts to develop guidelines are likely to continue unabated for the foreseeable future. Additional research comparing different methods of developing and disseminating guidelines is needed.

Is the medical care provided by your doctor in compliance with what other providers in his specialty do for their patients in the same circumstances? Does he follow evidence-based consensus statements or clinical practice guidelines? These questions show two sides of the definition of the standard of care in the medical setting. In legal terms, a standard of care is used as the benchmark against a doctor's actual work. What constitutes the standard of care will change from community to community as well as evolve over time.

A standard of care can also refer to informal or formal guidelines that are generally accepted in the medical community for the treatment of a disease or condition. It may be developed by a specialist society or organization and the title of standard of care awarded at their own discretion. It can be a clinical practice guideline, a formal diagnostic and treatment process a doctor will follow for a patient with a certain set of symptoms or a specific illness. That standard will follow guidelines and protocols that experts would agree with as most appropriate, also called best practice. Standards of care are developed in a number of ways: Sometimes they are simply developed over time, and in other cases, they are the result of clinical trial findings.

In the report on medical standards of care, the Institute of Medicine established a taxonomy of standards that remains relevant today. According to this taxonomy, the following types of medical standards are used currently in the United States:

  1. Standards of quality: statements of the minimum acceptable level of performance or results, what constitutes excellent performance or results, and the range in between.
  2. Medical (or clinical) practice guidelines: systematically developed statements to assist practitioners in their decision making in specific clinical settings.
  3. Medical review criteria: statements used to assess the appropriateness of specific decisions, services, and outcomes in the delivery of health care.
  4. Performance measures: specific measures of a quantitative nature that estimate or monitor compliance with medical quality standards, medical practice guidelines, and medical review criteria by health care professionals.

The movement toward integrated systems for delivery of care and managed care plans also fueled the development and use of medical standards. Medical standards became a critical tool for comparing managed care plans in a competitive environment - a phenomenon consistent with the best of managed competition theory, which emphasizes state-of-the-art quality measurement as a primary strategy for comparing competing health plans.

With this move, however, come increasingly difficult questions. Medical standards now come from a multitude of sources. How do these sources derive their authority? Are the processes used in setting standards open, transparent, and designed in a way to marshal the best information to guide clinical practice? Only by applying medical standards of care and evidenced-based medicine can inappropriate care be identified in a manner that is credible to physicians and patients.

The American health care sector has indeed moved from a paradigm of autonomous professional decision making to a paradigm of collective decision making based on empirically derived standards of care. In sum, medical standards of care are here to stay as an important part of American medicine.

Medical directions



















^ Back to Top