Physician characteristics and the reported effect of evidence-based practice guidelines.

In 2002, health spending in the United States had climbed to 14.9 percent of the gross domestic product (GDP), advancing much faster than the rest of the U.S. economy and is projected to rise to $3.4 trillion or 18.4 percent in 2013 (Centers for Medicare and Medicaid Services 2004; Levit et al. 2004). Concerns about the rapid growth in health expenditures are coupled with disturbing reports, such as those published by the Institute of Medicine (IOM), that attribute up to 98,000 unnecessary inpatient deaths per year due to medical error (IOM 2000) and suggest Americans are not receiving care that is based on the best scientific knowledge (IOM 2001). Although the IOM reports contributed significantly to increasing safety and quality awareness issues among health care providers, leaders are calling for a national commitment toward improving patient safety and quality of care (Leape and Berwick 2005). A promising tool for reducing medical error, improving quality of care, and lowering health care cost is the development and use of evidence-based clinical practice guidelines (Cydulka et al. 2003; Maue et al. 2004; Timmermans and Mauck 2005). Hauck, Adler, and Mulla (2004) found that patients with community-acquired pneumonia (CAP) who were placed on a CAP clinical practice guideline had a decreased length of stay, lower odds of hospital mortality, and decreased total patient charges. Similarly, researchers found that patients with unstable angina pectoris and non–ST-segment elevation myocardial infarction who received care concordant with evidence-based practice guidelines had substantially improved long-term survival rates (Allen et al. 2004). In 1999, the American College of Obstetricians and Gynecologists (ACOG) issued a practice guideline on vaginal birth after cesarean section (VBAC) and trial of labor (TOL). The guideline recommended that a physician be immediately available during TOL in the rare case of complications. Since the 1999 update of this clinical practice guideline, obstetrical providers in Utah have decreased use of TOL and more repeat cesarean sections are performed (Gochnour, Ratcliffe, and Stone 2005). Evidence-based clinical guidelines for acute respiratory tract infections, such as acute otitis media and acute sinusitis, have been associated with improving quality of care by assisting physicians to accurately diagnose these conditions, provide treatment rationales, and reduce the costs associated with inappropriate antibiotic prescriptions (McCracken 2001). While the above examples illustrate compelling evidence for the use of clinical practice guidelines, the preponderance of literature examines reasons for poor implementation and adherence to practice guidelines. There is, additionally, limited research examining the characteristics of the physicians who use practice guidelines. The purpose of this paper is to identify and explore physician and practice characteristics that contribute to the effect physicians report practice guidelines have on their practice of medicine.