The paradox of guideline implementation: how AHCPR's depression guideline was adapted at Kaiser Permanente Northwest Region.

J. B. Brown, D. Shye, Bentson McFarland

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

BACKGROUND: To ensure implementation, the Agency for Health Care Policy and Research's (AHCPR) Guideline for the Treatment of Depression in Primary Care was recently translated into a local document by a large health maintenance organization (HMO). The guideline revision process was studied on the basis of interviews with members of the guideline revision committee and others, observation of meetings, and documents and correspondence. WHY THE GUIDELINE WAS CHANGED: The HMO changed the AHCPR guideline for reasons of convenience, credibility, audience, purpose, and context. For example, in their roles as representative consumers, committee members perceived that the AHCPR guideline, although addressed to primary care clinicians, was actually written from a psychiatric perspective and based on a psychiatric literature not relevant to primary care. COMPARISON OF THE GUIDELINES: Although the guidelines differ dramatically in length and format, coverage, emphasis, and organizing principle, substantive conflict between the two guidelines' recommendations is minimal. For example, the emphasis on medication is greater in the adaptation, which adds considerable original material of a practical nature on drugs and drug use. In addition, the original guideline has a "research literature orientation." In contrast, the adaptation is described as "clinical decision oriented", identifying the key actions and decisions that a practicing clinician must make to treat depression. DISCUSSION AND IMPLICATION: Translation of science-oriented national guidelines into user-oriented documents tailored to local audiences and settings can add great value to the guideline development process without sacrificing science-derived integrity-and is probably essential to successful implementation.

Original languageEnglish (US)
Pages (from-to)5-21
Number of pages17
JournalThe Joint Commission Journal on Quality Improvement
Volume21
Issue number1
StatePublished - Jan 1995
Externally publishedYes

Fingerprint

Guidelines
United States Agency for Healthcare Research and Quality
Primary Health Care
Health Maintenance Organizations
Psychiatry
Committee Membership
Pharmaceutical Preparations
Observation
Interviews
Research

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The paradox of guideline implementation : how AHCPR's depression guideline was adapted at Kaiser Permanente Northwest Region. / Brown, J. B.; Shye, D.; McFarland, Bentson.

In: The Joint Commission Journal on Quality Improvement, Vol. 21, No. 1, 01.1995, p. 5-21.

Research output: Contribution to journalArticle

@article{b7dbe225e0af4f29aa6718bcbfff9ebf,
title = "The paradox of guideline implementation: how AHCPR's depression guideline was adapted at Kaiser Permanente Northwest Region.",
abstract = "BACKGROUND: To ensure implementation, the Agency for Health Care Policy and Research's (AHCPR) Guideline for the Treatment of Depression in Primary Care was recently translated into a local document by a large health maintenance organization (HMO). The guideline revision process was studied on the basis of interviews with members of the guideline revision committee and others, observation of meetings, and documents and correspondence. WHY THE GUIDELINE WAS CHANGED: The HMO changed the AHCPR guideline for reasons of convenience, credibility, audience, purpose, and context. For example, in their roles as representative consumers, committee members perceived that the AHCPR guideline, although addressed to primary care clinicians, was actually written from a psychiatric perspective and based on a psychiatric literature not relevant to primary care. COMPARISON OF THE GUIDELINES: Although the guidelines differ dramatically in length and format, coverage, emphasis, and organizing principle, substantive conflict between the two guidelines' recommendations is minimal. For example, the emphasis on medication is greater in the adaptation, which adds considerable original material of a practical nature on drugs and drug use. In addition, the original guideline has a {"}research literature orientation.{"} In contrast, the adaptation is described as {"}clinical decision oriented{"}, identifying the key actions and decisions that a practicing clinician must make to treat depression. DISCUSSION AND IMPLICATION: Translation of science-oriented national guidelines into user-oriented documents tailored to local audiences and settings can add great value to the guideline development process without sacrificing science-derived integrity-and is probably essential to successful implementation.",
author = "Brown, {J. B.} and D. Shye and Bentson McFarland",
year = "1995",
month = "1",
language = "English (US)",
volume = "21",
pages = "5--21",
journal = "Joint Commission Journal on Quality and Patient Safety",
issn = "1553-7250",
publisher = "Joint Commission Resources, Inc.",
number = "1",

}

TY - JOUR

T1 - The paradox of guideline implementation

T2 - how AHCPR's depression guideline was adapted at Kaiser Permanente Northwest Region.

AU - Brown, J. B.

AU - Shye, D.

AU - McFarland, Bentson

PY - 1995/1

Y1 - 1995/1

N2 - BACKGROUND: To ensure implementation, the Agency for Health Care Policy and Research's (AHCPR) Guideline for the Treatment of Depression in Primary Care was recently translated into a local document by a large health maintenance organization (HMO). The guideline revision process was studied on the basis of interviews with members of the guideline revision committee and others, observation of meetings, and documents and correspondence. WHY THE GUIDELINE WAS CHANGED: The HMO changed the AHCPR guideline for reasons of convenience, credibility, audience, purpose, and context. For example, in their roles as representative consumers, committee members perceived that the AHCPR guideline, although addressed to primary care clinicians, was actually written from a psychiatric perspective and based on a psychiatric literature not relevant to primary care. COMPARISON OF THE GUIDELINES: Although the guidelines differ dramatically in length and format, coverage, emphasis, and organizing principle, substantive conflict between the two guidelines' recommendations is minimal. For example, the emphasis on medication is greater in the adaptation, which adds considerable original material of a practical nature on drugs and drug use. In addition, the original guideline has a "research literature orientation." In contrast, the adaptation is described as "clinical decision oriented", identifying the key actions and decisions that a practicing clinician must make to treat depression. DISCUSSION AND IMPLICATION: Translation of science-oriented national guidelines into user-oriented documents tailored to local audiences and settings can add great value to the guideline development process without sacrificing science-derived integrity-and is probably essential to successful implementation.

AB - BACKGROUND: To ensure implementation, the Agency for Health Care Policy and Research's (AHCPR) Guideline for the Treatment of Depression in Primary Care was recently translated into a local document by a large health maintenance organization (HMO). The guideline revision process was studied on the basis of interviews with members of the guideline revision committee and others, observation of meetings, and documents and correspondence. WHY THE GUIDELINE WAS CHANGED: The HMO changed the AHCPR guideline for reasons of convenience, credibility, audience, purpose, and context. For example, in their roles as representative consumers, committee members perceived that the AHCPR guideline, although addressed to primary care clinicians, was actually written from a psychiatric perspective and based on a psychiatric literature not relevant to primary care. COMPARISON OF THE GUIDELINES: Although the guidelines differ dramatically in length and format, coverage, emphasis, and organizing principle, substantive conflict between the two guidelines' recommendations is minimal. For example, the emphasis on medication is greater in the adaptation, which adds considerable original material of a practical nature on drugs and drug use. In addition, the original guideline has a "research literature orientation." In contrast, the adaptation is described as "clinical decision oriented", identifying the key actions and decisions that a practicing clinician must make to treat depression. DISCUSSION AND IMPLICATION: Translation of science-oriented national guidelines into user-oriented documents tailored to local audiences and settings can add great value to the guideline development process without sacrificing science-derived integrity-and is probably essential to successful implementation.

UR - http://www.scopus.com/inward/record.url?scp=0029192882&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029192882&partnerID=8YFLogxK

M3 - Article

C2 - 7719400

AN - SCOPUS:0029192882

VL - 21

SP - 5

EP - 21

JO - Joint Commission Journal on Quality and Patient Safety

JF - Joint Commission Journal on Quality and Patient Safety

SN - 1553-7250

IS - 1

ER -