Clinical Practice Guidelines

AHCPR-sponsored guidelines help users increase quality and cut costs

The Agency for Health Care Policy and Research's experience with clinical practice guidelines has demonstrated that evidence-based practice recommendations can be incorporated into guidelines for a range of providers and programs that yield major improvements in outcomes and costs. As reported previously (in the April 1996 issue of Research Activities), AHCPR is no longer directly involved in developing clinical practice guidelines. The Agency will focus instead on assisting private-sector groups by supplying them with the scientific evidence they need to develop their own guidelines.

The following examples describe how evidence-based guidelines developed from AHCPR's work are being used.

• Florida's Agency for Health Care Administration developed a practice guideline for treating low back pain based largely on AHCPR's guideline. It is expected to save the State nearly $100 million in a single year of workers' compensation direct health care costs.
• Kentucky now requires insurers handling workers' compensation claims for back injury to use the State's new low back pain practice parameter as the standard for utilization review. The parameter closely follows AHCPR's acute low back problems guideline.
• The California Division of Workers' Compensation, Colorado Department of Labor and Employment, Connecticut Workers' Compensation Commission, Montana Department of Labor and Industry, Oklahoma Workers' Compensation Court, Texas Workers' Compensation Commission, and Utah Industrial Commission have used or are using AHCPR's acute low back problems guideline to help develop their own back pain treatment guidelines.
• The Ohio Department of Human Services endorsed AHCPR's heart failure guideline and notified over 20,000 physicians practicing in the State of the anticipated health care improvements and cost savings that could result from following the guideline.
• Maryland designated AHCPR's urinary incontinence guideline as a standard to be followed by public and private health care organizations within the State.
• California requires that all physicians practicing in the State be made aware of AHCPR's acute pain management guideline.
• Texas' long-term care facility surveyors use AHCPR's pressure ulcer prevention and urinary incontinence guidelines to help identify and correct problems in the State's 2,378 nursing homes, personal care homes, and facilities for the mentally retarded.

A growing number of employers are using AHCPR guidelines and consumer guides, including Bristol-Myers Squibb. At the company's New Brunswick, NJ, facility, AHCPR's acute low back problems guideline is helping physicians treat employees' low back problems successfully for one-fifth of the national average cost. Examples from other corporate users include:

• Employees of Consolidated Edison Company of New York, Inc., who were treated for acute low back pain according to recommendations in AHCPR's guideline returned to work about 2 weeks sooner than workers treated by more traditional methods.
• Hewlett-Packard developed a company protocol for handling employees' back problems that closely parallels the recommendations in AHCPR's guideline.

Insurers also are using AHCPR's acute low back problems guideline. For example, the guideline has helped Houston, TX-based WorkCare, Inc., to curb medically unnecessary MRI scans and contest other claims that appear unjustified, such as overuse of prescription medicines.

Zenith Insurance Company, a Woodland Hills, CA-based insurer, has cut costs for back pain treatment by 65 percent, in part by creating treatment protocols based on AHCPR's acute low back problems guideline and sending the protocols to physicians who treat workers' compensation patients.

Managed care organizations, hospitals, home health agencies, and nursing homes also use AHCPR's guidelines. For example:

• CAPP CARE, Inc., a 3.8 million-member preferred provider organization based in Newport Beach, CA, is developing a prototype software application run on a portable hand-held device that will allow its 110,000 physicians to quickly access guidelines developed by AHCPR and others and match the guidelines' recommendations to patients' diagnoses.
• Gulf Atlantic Management Group, a large Florida-based preferred provider network, is integrating copies of AHCPR's acute low back problems guideline into its manual for current physician providers and newly contracted PPO and HMO providers.
• AHCPR's acute pain management guideline has helped shorten the hospital stays of surgical patients at Memorial Medical Center in Modesto, CA, by an average of 3.5 days.
• Use of AHCPR's unstable angina guideline has helped North Mississippi Medical Center in Jackson reduce test costs for emergency room patients complaining of chest pain.
• Staff at the Heritage Manor Nursing Home in Chattanooga, TN, used AHCPR's pressure ulcer prevention and urinary incontinence guidelines to cut the number of incontinent residents from 52 to 18 and the number of residents with pressure ulcers from 14 to 5.

AHCPR's quick reference guides for clinicians and consumer guides are available from AHCPR's clearinghouse. The quick reference guides, full clinical practice guidelines, and consumer guides also are available online from AHCPR's Web site. Access these documents by using a Web browser, specifying URL http://www.ahrq.gov/clinic/, and clicking on "Clinical Practice Guidelines Online." A third source is the U.S. Government Printing Office, which sells individual copies of clinical practice guidelines and bulk copies of quick reference guides and consumer guides. For more information, call the GPO order desk at (202) 512-1800.

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