SAN DIEGO--Hospitals are facing tremendous pressures from the
insurance industry to standardize treatments by adopting clinical
practice guidelines, panel members said at a conference sponsored
by the Society for Ambulatory Care Professionals and Health Technology
Assessment of the American Hospital Association.
As a practical matter, hospitals contemplating the development
of their own guidelines do not have to be as exhaustive in their
research as some of the professional societies, said Rodger J.
Winn, MD, chief of the section of community oncology at the University
of Texas M.D. Anderson Cancer Center, and chairman of the Guidelines
Committee of the National Comprehensive Cancer Network (NCCN).
But on the flip side, he warned, guidelines development must be
based on objective sources and not merely standardize current
practice. "Don't simply ask a couple of surgeons at your
hospital to draw up procedures based on what they do in the operating
room," he said.
The most rigorous method of guidelines development is to pursue
an evidence-based consensus. "You look at all the literature
and then grade each study," Dr. Winn said, but he also suggested
a shortcut to this process.
"Bring together experts, including subspecialists, in a room,"
he said. "They will know the four or five trials that are
the most pertinent. You don't have to look at all 12,000 articles
in the literature--they know the five that really shape the decision."
Let these experts develop the guidelines, Dr. Winn said, and then
send the document out to a dozen other experts for feedback.
This was the type of procedure used by the guidelines committee
of the National Comprehensive Cancer Network, Dr. Winn said. The
NCCN is a consortium of 15 major cancer centers that has developed
preliminary guidelines for eight of the most common neoplasms
and is currently devising eight additional site-specific pathways.
Dr. Winn also stressed the importance of developing goals from
the beginning. "If you don't decide on the outcomes up front,
you can never do the guidelines at the end." Goals for shorter
hospitalization could result in one set of treatment recommendations,
while targeting longer survival of cancer patients could result
in another, he said.