'Best clinical practice': Assessment of processes of care and of outcomes in the US Military Health Services System

Henry Krakauer*, Monica Jia Yeong Lin, Eric M. Schone, Dae Park, Richard C. Miller, Jeffrey Greenwald, R. Clifton Bailey, Barbara Rogers, Geoffrey Bernstein, David E. Lilienfeld, Sidney M. Stahl, Raymond S. Crawford, David C. Schutt

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


The National Quality Management Program of the Military Health Services System of the United States has undertaken a series of projects whose objective is the active, on-going monitoring and improvement of the effectiveness and efficiency of the care provided to a broad population that encompasses troops on active duty, retirees and dependents. The analytic activities consist of (1) identification by clinical panels of conditions and procedures of interest; (2) collection of data from electronic repositories and from charts to characterize the patients, how they are managed, the clinical outcomes they experience, the resource costs their care entails, and, from questionnaires, their functional status and level of satisfaction, and (3) generation of 'report cards' that inform organizational units down to the level of the hospital of the characteristics of their patients, their practices, and the risk-adjusted outcomes they achieve. The patterns of care employed by the hospitals that obtain the best risk-adjusted outcomes and resource utilization ('best clinical practice') are identified and made known. In addition, (4) a systematic process of developing outcomes-based practice guidelines has been devised. Its intent is to serve as a decision-support tool for clinicians. Initial estimates have been obtained of the probable consequences of the application of this tool to operative interventions in childbirth. Use of the tool would result in a higher occurrence of elective Caesarean sections, a reduced rate of emergency Caesarean sections and much lower use of forceps, with an overall improvement in outcomes and lower resource costs. This program is currently in the early phases of implementation. The two principal requirements for the immediate future are (1) education of the clinical and administrative communities in the use of the data and the decision-support tools and (2) evaluation of the consequences of the use of the data by the clinical and administrative communities.

Original languageEnglish
Pages (from-to)11-29
Number of pages19
JournalJournal of Evaluation in Clinical Practice
Issue number1
StatePublished - 1998
Externally publishedYes


  • Best practice
  • Decision making
  • Outcome
  • Process


Dive into the research topics of ''Best clinical practice': Assessment of processes of care and of outcomes in the US Military Health Services System'. Together they form a unique fingerprint.

Cite this