In the 2000s, Dr. Beth McGlynn表示，接受推荐治疗的比率很低. In a new JAMA editorial, Dr. David Grossman has ideas to improve them

by David Grossman, MD, MPH, 凯撒永久华盛顿健康世界杯下注网站所(KPWHRI)华盛顿永久医疗集团的高级世界杯下注网站员和儿科医生

In 2003, a study by my colleague Dr. Beth McGlynn, vice president of 2022世界杯下注网站 Research, set off discussions among physicians, health care system executives, and health policy experts across the country. 当时，贝丝是兰德医疗保健质量世界杯下注网站中心的主任. In the New England Journal of Medicine, 她和她的合著者对美国12个州数千名成年人的调查和医疗记录数据进行了分析.S. 调查发现，成年人只接受了推荐治疗的55%.

In 2007, Dr. Rita Mangione-Smith, 华盛顿大学普通儿科和医院医学部主任, with Beth and their colleagues, found even worse numbers for U.S. children他们平均只接受了不到46%的推荐治疗. In the two studies, 世界杯下注网站人员发现，无论是成人还是儿童, results varied by condition. However, 10年前的主要教训很清楚:在按照国家指导方针提供一致的护理方面, U.S. health care had a lot of room to improve.

NEJM
美国儿童门诊护理的质量vww.nejm.org

Adherence to guidelines is still low

A new study in the Journal of the American Medical Association 显示，遵循儿科临床护理指南的比率仍然很低，而且这个问题并不局限于美国. 这份报告来自澳大利亚的世界杯下注网站人员，我被要求写一篇配套的社论。”儿童保健质量:需要可靠证据的坚实基础” to their article.

Quality of Health Care for Children
自从美国国家医学院(NAM)(当时的医学世界杯下注网站所)发表……jamanetwork.com

与兰德公司之前的世界杯下注网站结果一致, the researchers found that in their country, 据估计，只有60%的儿童接受了符合临床指南建议的治疗. As a health care researcher, health system leader, and pediatrician, 我明白，按照指导方针提供更好的护理意味着要克服多个领域的许多挑战. 但我和KPWHRI以及凯泽医疗机构其他世界杯下注网站中心的同事们可以解决的一个问题是，提供证据，让医生对指南更有信心.

临床医生希望提供最高质量的护理, 但我们并不总是确定国家的建议和指导方针，以及它们如何适用于我们的病人. One detail I noticed in the Australian study was how little was known about the evidence behind the clinical practice guidelines that they used to assess adherence to recommended care; more than 74 percent lacked formal evidence grading. 我相信，当我们知道指导方针都有可靠的世界杯下注网站结果支持时，治疗成人和儿童的医生会对指导方针更有信心.

一个例子是筛查儿童的高血脂，如胆固醇. A recent study in Journal of Pediatrics found that less than half of U.S. 儿科医生遵循儿童脂质筛查指南, for example, the American Academy of Pediatrics. A companion commentary 该世界杯下注网站指出，对指导方针的遵守程度较低的一个原因可能是美国.S. Preventive Services Task Force (USPSTF), of which I’m the chair, 没有足够的证据支持USPSTF关于这种做法的建议.

A path to better guidelines

当严格的世界杯下注网站结果表明指导方针是对患者健康产生积极影响的最佳方式时，儿科医生可能更有可能遵循指导方针. 我们已经有了一个指南针指向我们需要的世界杯下注网站:USPSTF在2014年发布了儿童预防服务方面的关键证据差距 report to Congress.

向国会提交的关于临床预防服务高优先证据差距的第四次年度报告 …
提交给国会的关于临床预防服务高优先证据差距的第四次年度报告.uspreventiveservicestaskforce.org

Almost 15 years ago, Beth McGlynn和同事们开始呼吁人们注意这样一个事实，即许多人没有接受推荐的治疗. There are many reasons for this shortfall. 但医疗保健世界杯下注网站人员可以帮助解决变量的问题, low-quality, non-guideline-based care. 我们需要加倍努力，从随机对照试验中为儿童健康提供高质量的证据, observational studies, 与卫生保健系统密切合作进行的务实世界杯下注网站, and other innovative projects. 我们可以为临床同事提供高质量的证据，使医疗保健指南更加有力，从而为他们提供最好的医疗服务.

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