FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 355:1640-1642 October 19, 2006 Number 16 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF PDA Full Text Purchase this article Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

Practice guidelines approved by expert panels are intended to standardize care in such a way as to improve health outcomes. In recent years, the developers of such standards have started grouping evidence-based interventions into "bundles," on the theory that inducing physicians to follow multiple recommendations written into a single protocol has a measurable effect on patients' outcomes. As a side effect, bundled performance measures are ready-made for use in pay-for-performance initiatives, which can base reimbursement on compliance with all the components.

Unfortunately, the development of such clusters is vulnerable to manipulation for inappropriate — and possibly harmful — ends. Seeing . . . [Full Text of this Article]

Source Information

Drs. Eichacker, Natanson, and Danner are senior investigators in the Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD. The opinions expressed are those of the authors and do not reflect the policies of the National Institutes of Health, the Public Health Service, or the Department of Health and Human Services.

This article has been cited by other articles:

• Iserson, K. V., Cerfolio, R. J., Sade, R. M. (2007). Politely Refuse the Pen and Note Pad: Gifts From Industry to Physicians Harm Patients. Ann. Thorac. Surg. 84: 1077-1084 [Full Text]  
• Sladen, R. N. (2007). Severe sepsis: a bundle still under construction?/La septicemie severe: un lot encore en travaux ?. Canadian J. Anesthesia 54: 779-785 [Full Text]  
• Malhotra, A. (2007). Low-Tidal-Volume Ventilation in the Acute Respiratory Distress Syndrome. NEJM 357: 1113-1120 [Full Text]  
• Sinuff, T., Eva, K. W., Meade, M., Dodek, P., Heyland, D., Cook, D. (2007). Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians' attitudes: [Guide de pratique clinique dans les unites de soins intensifs : un sondage sur les attitudes des cliniciens canadiens]. Canadian J. Anesthesia 54: 728-736 [Abstract] [Full Text]  
• Tonelli, M. R. (2007). Conflict of Interest in Clinical Practice. Chest 132: 664-670 [Abstract] [Full Text]  
• Fong, J. J, Cecere, K., Unterborn, J., Garpestad, E., Klee, M., Devlin, J. W (2007). Factors Influencing Variability in Compliance Rates and Clinical Outcomes Among Three Different Severe Sepsis Bundles. The Annals of Pharmacotherapy 41: 929-936 [Abstract] [Full Text]  
• Remick, D. G. (2007). Pathophysiology of Sepsis. Am. J. Pathol. 170: 1435-1444 [Abstract] [Full Text]  
• Califf, R. M. (2007). The cycle of quality as a model for improving health outcomes in the treatment of hypertension. Eur Heart J Suppl 9: B8-B12 [Abstract] [Full Text]  
• (2006). Marketing Sepsis Guidelines: Eli Lilly and Protein C. JWatch Emergency Med. 2006: 5-5 [Full Text]