Practice Guidelines and Practice Variation: Diagnostic Technology in Maternity Care

Abstract

One of the most common measures for reducing practice variation is the use of practice guidelines. They are meant to limit the use of services that are of little or questionable value and to increase the use of services that are cost-effective, but underused. A general finding is that guidelines often have a limited effect on practice variation, mainly because adherence is weak. This is supported by the findings from extensive reviews of professional behavior change interventions. The conclusion from these reviews is that for most interventions, the effects are small. Guidelines can be effective in reducing practice variation if physicians experience that they improve clinical decision making and/or treatment outcomes. Adherence to guidelines may then be high. This is supported by studies from maternity care in Norway. During the 1970s and 1980s, ultrasound and cardiotocography were introduced as diagnostic tools for deciding on mode of delivery. The guidelines for these diagnostic tools provide clear indications for which conditions and test values indicate Cesarean section. Objective criteria then replaced more subjective criteria based on clinical judgment. Clinical uncertainty about diagnosis of risk factors of the mother and child during delivery was then reduced. Variation in type of delivery between hospitals was reduced accordingly.