Surviving Sepsis — Practice Guidelines, Marketing Campaigns, and Eli Lilly

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 . . .