Monitoring adherence to guidelines.

In our current medical environment, which is characterized by oversight, accountability, practice guidelines, and documentation, it was inevitable that practice patterns would be monitored to rank compliance with guidelines as an index of the quality of care. It is a small step to a “pay-for-performance” approach, which is well intentioned because it uses data from clinical trials and guideline recommendations to reward physicians who are using treatment strategies known to be effective. Such an approach is aimed at identifying and reforming doctors who do not use “evidence-based” therapy. Article see p 98 In this issue of Circulation: Heart Failure , Fonarow and colleagues1 review the data on >15000 patients with heart failure cared for in 167 outpatient cardiology practices in the United States. The results can be viewed as encouraging or discouraging, depending on your expectations, and as an optimistic step in the right direction to ensure quality care or as a depressing retreat from individualized …