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Medicine has an inefficient knowledge market. Patients often receive half of the recommended therapies and it takes over 15 years for evidence to be incorporated into routine practice. The IOM report on comparative effectiveness research highlighted the need to produce evidence that is useful to decision makers.1
In medicine evidence is usually summarized in practice guidelines, which are needed and often elegant and scholarly literature summaries, developed by professional organisations or government agencies are used to shape clinical practice standards. The purpose of these guidelines is to help ensure that patients receive recommended therapies, yet often they are neither used nor as useful as the developers would like.2 As Schnoor et al illustrate (see page 498), it is often difficult to demonstrate that guidelines improve patient care even with an implementation strategy in place.3 This may be because of clinician barriers (they do not know about or agree with the evidence), guideline barriers (the guideline may be ambiguous or not associated with outcomes), system barriers (the supplies needed to comply with the guideline may not be readily available) or implementation barriers (the way the guideline was introduced engendered resistance).4
A proposal: use guidelines to develop checklists
We propose that guidelines should not be viewed as a final product to guide clinical practice but rather as an input for a more succinct tool—a checklist. Checklists are not Harry Potter's wand and when used alone will probably be no more effective than guidelines.5 Yet when used as part of a conceptual model to identify local barriers to compliance, to measure and feedback performance, and to change the local work system to ensure patients receive the checklist items, it can lead to significant improvement.6 7 In this essay, we discuss some …
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