How to create, implement, and refine regional clinical guidelines for office use

Objective. To help pediatricians create practical, sound and useful clinical guidelines that begin to establish a standard of care, and which are applicable in practice settings and produce quality information about functional health outcomes over time. Methods. We developed and implemented practice guidelines using acute otitis media as an example via collaboration among academic and community pediatricians and their office staff. The process of practical guideline development involved three steps, while the process of implementing and evaluating the guidelines required four phases. Results. The process produced a collaborative pediatric office guideline, small sample tests of guideline effectiveness, and preliminary outcomes data. Health professionals maintained control of decision-making on quality of care with enhanced ability to document costs and parent satisfaction. Conclusions and implications for practice. Collaboration among university and community pediatricians helped create an effective, useful guideline which was tested in a single practice. This collaboration was enabled by community providers who were highly invested in the goals of developing and evaluating guidelines. The outcomes information collected appears useful as baseline data for continued efforts to improve health outcomes, functional health status, and parent satisfaction while reducing costs. These data may also influence managed care organizations to implement these guidelines as a common standard of care.