Problems With Evaluating the Effect of a Guideline
As previously discussed, there is a tendency to evaluate a guideline's effects, both benefits and harms, in the context of a single disease or behavior. One might implement a program that is effective from this narrow perspective but, from a broader view, actually reduces the overall benefits to some patients. In other words, the evaluation usually informs a narrow question (eg, "Did the rate of diabetic retinopathy decrease?"), not the effect on the patient (eg, "Is the patient better off overall?) or the total system (eg, "What is the effect on the health of my patient population?"). These latter questions are more relevant if the ultimate goal is to maximize overall health as opposed to treating a single disease.