Shortly after its creation, AHCPR requested advice from the Institute of Medicine (IOM) on how it might approach these new responsibilities for practice guidelines. The IOM agreed to appoint a study committee that would work quickly to provide technical assistance and advice on definition of terms, specification of key attributes of good guidelines, and certain aspects of planning for implementation and evaluation. This report largely confines itself to these fairly specific and limited tasks. It is not a how-to-do-it manual, a methodology text, a priority-setting exercise, or a primer on guidelines for those seeking an introduction to the subject. The report does, however, aim to encourage more standardization and consistency in guidelines development, whether such development is supported directly by the Forum or is undertaken independently by medical societies and other organizations.

Contents

• COMMITTEE TO ADVISE THE PUBLIC HEALTH SERVICE ON CLINICAL PRACTICE GUIDELINES
• Acknowledgments
• Summary
• 1. Introduction and Background
  • Context
  • Overview of Practice Guidelines Initiatives
  • Specific Responsibilities of AHCPR
  • The Institute of Medicine Committee and Project
  • Overview of the Report
  • Conclusions and Cautionary Notes
  • References
• 2. Definitions of Key Terms
  • The Committee's Approach
  • Practice Guidelines
  • Evaluation Instruments
  • Medical Review Criteria
  • Standards of Quality
  • Performance Measures
  • Conclusions and Summary
  • References
• 3. Attributes of Good Practice Guidelines
  • Background and Terminology
  • Working Assumptions
  • Principles
  • Past Work on Defining Attributes
  • Attributes for Assessing Practice Guidelines: Overview
  • Validity
  • Reliability/Reproducibility
  • Clinical Applicability
  • Clinical Flexibility
  • Clarity
  • Multidisciplinary Process
  • Scheduled Review
  • Documentation
  • Conclusion
  • References
• 4. Implementation and Evaluation
  • Types of Implementation
  • Links Between Development and Implementation Stages
  • Planning for Implementation
  • Elements of Implementation
  • Evaluation of Guidelines
  • Conclusion
  • References
• 5. Conclusions and Recommendations
  • Findings and Conclusions
  • Recommendations: Definitions
  • Recommendations: Attributes of Good Guidelines
  • Recommendations: Implementation and Evaluation
  • Diversity in Clinical Practices and Guidelines
  • Concluding Comments
• Appendix A The Omnibus Budget Reconciliation Act of 1989
• Appendix B Examples of Practice Guidelines
• Appendix C Next Steps for the Institute of Medicine
• Appendix D Biographies of Committee Members

This project was supported by the Department of Health and Human Services, Contract No. 282-90-0018. The views presented are those of the Institute of Medicine Committee to Advise the Public Health Service on Clinical Practice Guidelines and are not necessarily those of the funding organization. The Andrew W. Mellon Foundation contribution to independent Institute of Medicine funds was also used to support the project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.