Individualized Guidelines May Improve Quality of Care

Calculating risk reduction expected from treatment based on characteristics may reduce costs

WEDNESDAY, May 4 (HealthDay News) -- Individualized guidelines that calculate the risk reduction expected from treatment, and which rank individuals in order of decreasing expected benefit, may be useful for increasing the quality and reducing the cost of care, according to a study published in the May 3 issue of the Annals of Internal Medicine.

David M. Eddy, M.D., Ph.D., from Archimedes in San Francisco, and colleagues compared current guidelines with individualized guidelines using readily available personal characteristics in the context of blood pressure management in the Atherosclerosis Risk in Communities Study. Individuals without pre-existing cardiovascular disease who were not currently receiving antihypertensive therapy were treated according to criteria of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7 guidelines), individualized guidelines (treatment of individuals in decreasing order of expected benefit), or random care. The number of myocardial infarctions (MIs) and strokes, and medical costs were assessed.

The investigators found that using individualized guidelines could prevent the same number of MIs and strokes as JNC 7 guidelines at a saving of 67 percent, or could prevent 43 percent more MIs and strokes for the same cost as the JNC 7 guideline treatment, compared to treating people according to random care. The improvement of individualized guidelines was not sensitive to various assumptions about costs, effectiveness of treatment, cardiovascular risk levels in the population, and effect on workflow, but it was sensitive to the accuracy of the technique used to rank patients.

"Individualized guidelines can potentially improve quality and reduce costs compared with current population-based guidelines," the authors write.

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