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Numerous Flaws in the Guidelines

Tick borne diseases offers unique health care challenges. Well-written guidelines can offer a unique opportunity to address them. Numbers of tick borne disease cases continue to increase along with missed or late diagnoses and unacceptable levels of treatment failure. By employing root cause analysis, some of these problems can be defined and corrected through guidelines that are clear and easy to use.

Numerous organizations agree that healthcare guidelines meet the following requirements: 1.)improving quality of care 2.) Improving process of care 3.) Improving patient outcomes.

To address root cause failures, it is important to ask: What actually happens to patients as they move through the health care system? What can be done differently? How do the guidelines remove barriers to rapid and accurate diagnosis?

Barriers to meeting requirements within these guidelines include:

• The guidelines are complex

• The guidelines are difficult to apply

• The guidelines do not translate naturally in simple, clear corrective action recommendations.

• The guidelines are often subjective because of a lack of data or data that fits an existing narrative.

• Treatment options are confusing with multiple options and uncertainty about outcomes.

• Patients are not easily diagnosed because of the complexity involved in administering the standard test. If testing is done too soon or after antimicrobials are given, the lab tests are frequently negative with hazards transferred to the patient when no treatment is provided.

• If patients wait several weeks before testing, the delay causes the disease to advance making complete recovery more difficult, again presenting a hazard to the patient.

• Solutions to prevent or treat long term or permanent disability caused by missed diagnosis or late diagnosis is not addressed.

Carefully considered guidelines are critical to preventing health, financial and social burdens from being borne by the patient and health care system, and eventually by taxpayers in the form of unemployment, disability payments, welfare, Medicaid and Medicare when patients are not properly diagnosed and treated.

I hope this is useful and offers constructive direction for revision.

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