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Repeated data analysis and collection should be carried out after the guidelines are disseminated and implemented. Such analysis will allow for continual assessment of changes in patterns of practice in relation to the guidelines and a redefinition of target areas for further promotion. It will also permit an assessment of whether or not health outcomes are improving.
Institutions should also collect data that can be usefully compared against national data. These data can be used in clinical audit and other quality assurance activities and will facilitate assessment of how the guidelines are affecting the routine care being delivered by clinicians and the effects of that care on the health of their patients.
Where possible, existing national, State and Territory and local data sources should be used, for both pre-guideline and post-guideline applications. In other circumstances customised surveys and other initiatives will be required. In many cases the local data collected can be fed back directly into clinical practice.
In providing data for guideline-evaluation purposes, some clinicians may feel it is necessary to seek protection from disclosure of this kind of information under quality assurance legislation. Such legislation exists at Commonwealth and State and Territory levels.
A wide variety of organisations monitor health care and health outcomes. For example, the Australian Council on Healthcare Standards has developed clinical indicators that may provide guidance. The clinical colleges are also collecting data for this purpose.
In some cases it will not be possible to measure health outcomes or the desirable outcomes will be such that immediate feedback is not possible. In these cases it is reasonable to use more immediate proxy measures of outcomes.
For example, mammographic screening programs will be judged effective only if they reduce mortality from breast cancer. Because of the lag time between initiation of screening and the anticipated reduction in mortality, it is reasonable to use a number of proxy measures in the first instance. Among the suitable proxies are tumour size and the degree of lymph node involvement at the time of diagnosis. Should these measures show the scale of improvement expected from the results of the original field trials, it will be reasonable to assume that mammographic screening is on track in terms of providing a benefit to those who take part in the program.
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