Clinical practice guidelines and performance measures can be used to improve quality of health care. Medical review criteria and performance measures are used to determine the extent to which care has followed specified processes and whether the expected outcomes have been achieved. Recently there are increasing tendencies to release the healthcare organisations’ performance to the public and to introduce pay-for-performance in many countries.

In countries where development, dissemination, and implementation of clinical practice guidelines are relatively slow, other interventions such as claims review activities, report cards, and pay-for-performance may have stronger influence on clinical practice in the real world than guidelines. In this presentation issues around the relationship among clinical practice guidelines, performance measures, claims review criteria, and clinical practice in the settings where guideline activities are not so active will be discussed