The I. Ridgeway Trimble Lecture Andrew L. Warshaw, MD, FACS, FRCSEd (Hon) Keywords: health care, outcomes, patient choice There are myriads of guidelines extant for clinical decisions, including the American College of Surgeons Evidence-Based Deci- (Ann Surg 2018;267:S52–S54) sions in Surgery, now numbering more than 100. Although these are the product of (good) surgical judgment, they are likely to differ from s the title of this perspective indicates, there are 2 components to comparable guidelines written by nonsurgeon specialists or primary A decisions about surgical care: What is appropriate and what are care physicians. Guidelines are subject to discipline-based opinion or the bases of choices? These decisions are a vector of views and varied weighting of factors. Even within the same field, the guide- requirements emanating from physicians, surgeons, payors, hospitals lines promulgated for the management of intraductal papillary and systems, and the patient and patient’s family (Fig. 1). mucinous neoplasms by the pancreatologists of the International It is commonly stated that that outcomes of health care are better Association of Pancreatology, the American Pancreatic Association, assessed by clinical measures than by administrative and claims data. and the American Gastrointestinal Association differ significantly. Similarly, there is a strong movement,
Annals of Surgery – Wolters Kluwer Health
Published: Feb 1, 2018
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