Introduction: "Clinical guidelines (or Care Plans) are a powerful method for standardization and uniform improvement of the quality of medical care. Clinical guidelines are a set of schematic plans, at varying levels of abstraction and detail, for management of patients who have a particular clinical condition (e.g., insulin-dependent diabetes). (Clinical protocols are typically highly detailed guidelines, often used in areas such as oncology and experimental clinical trials.) The application of clinical guidelines by care providers typically involves collecting and interpreting considerable amounts of data over time, applying standard therapeutic or diagnostic plans in an episodic fashion, and revising those plans when necessary.
"Clinical guidelines can be viewed as reusable skeletal plans that, when applied to a particular patient, need to be refined by a care provider over significant time periods, while often leaving considerable room for flexibility in the achievement of particular goals. Another view, which I will dwell upon in more length here, is that clinical guidelines are a set of constraints regarding the process of applying the guideline (i.e., care-provider actions) and its desired outcomes (i.e., patient states), to which I refer as process and outcome intentions. These constraints are mostly temporal, or at least have a significant temporal dimension, since most clinical guidelines concern the care of chronic patients, or at least specify a care plan to be applied over a significant period.
"It is now universally agreed that conforming to state-of-the-art guidelines is the best way to improve the quality of medical care, a fact that had been rigorously demonstrated [Grimshaw and Russel, 1993], while reducing the escalating costs of medical care. Clinical guidelines are most useful at the point of care (typically, when the care provider has access to the patient's record), such as at the time of order entry by the care provider."