variations in variability

Twest54973 twest54973 at YAHOO.COM
Tue Nov 1 17:30:42 UTC 2016


Guidelines are ideally based on prospective data not just opinion or biologic plausibility
When adequate data doesn't exist ( as is the case for VTE prevention in pregnancy), then different people and organizations create different "guidelines" based on their beliefs and biases

Its a shame (but not unexpected) that different professional associations act independently of each other : this  results in confusion in clinicians and even sometime active conflict between clinicians 

A contrary editorial accompanied the Natl Partnership article ...

Good luck to the bedside clinician trying to provide good clinical care!

Thomas Westover MD
Asst Professor Maternal Fetal Med and Obgyn
Cooper Medical School 
NJ


Sent from my iPhone

On Nov 1, 2016, at 10:13 AM, Tom Benzoni <benzonit at GMAIL.COM> wrote:

> A topic for awareness/discussion is guidelines.
> They need to support the person on the sharp end of the process, the practitioner advising the patient.
> So is it acceptable that there is variation among guidelines for the same condition?
> Would this be acceptable in other high risk industries?
> An example crossed my desk this morning:
> Comment
> 
> The variability among professional societies' recommendations for VTE prevention in pregnancy has hampered attempts at quality improvement. The NPMS challenges obstetric units to adopt all the features of this bundle in an endeavor to reduce the burden of maternal morbidity and mortality, both of which are disproportionately borne by poor women and those of color. Ideally, efforts to streamline recommendations and encourage measurement of important outcomes will promote equity and excellence in maternity care.
> 
> http://www.jwatch.org/na42624/2016/10/28/another-maternal-safety-bundle-obstetric-venous?ijkey=VLA13UO7mZVBs&keytype=ref&siteid=jwatch&variant=full-text
> 
> Is it not abrogation of responsibility to push this off onto the practitioner?
> 
> How do you reconcile this?
> 
> (There are legion examples of this in medicine.)
> 
> tom
> 
> 
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