In developing and defining its guiding principles, the committee also drew from important foundational work performed by others—most notably, several earlier Institute of Medicine (IOM) committees, including the Committee on Quality of Health Care in America, the Committee on Setting Priorities for Guidelines Development, and the Committee on Priorities for Assessment and Reassessment of Health Care Technologies; the Agency for Healthcare Research and Quality (AHRQ); the Cochrane Collaboration; the AGREE (Appraisal of Guidelines Research and Evaluation) Collaboration; the GRADE Working Group; and the National Quality Forum (AGREE Collaboration, 2001; AHRQ, 2007; Cochrane Collaboration, 2007; GRADE Working Group, 2004; IOM, 1992, 1995, 2001; NQF, 2006).

Box 6-1 defines eight guiding principles for organizing the Program: accountability, consistency, efficiency, feasibility, objectivity, responsiveness, scientific rigor, and transparency. The committee believes that each principle is integral to ensuring a valued, effective enterprise that instills credibility and trust in its products. The following sections further describe each principle.


For the Program, accountability refers to accepting the responsibility to meet and demonstrate compliance with a set of program performance standards. Under the status quo, a meaningful proportion of systematic reviews of clinical effectiveness are proprietary and their findings are available only to those who pay for them. The documentation on the methods used to conduct systematic reviews is uneven and often lacking, even when the review and analysis are presented in a journal or some other public medium (Moher et al., 2007). As a result, it may be impossible to determine if the review process was free from bias and met scientific and performance standards.


Consistency refers to the use of standardized and predictable methods. It is an important element not only in a program’s regulations and administrative procedures, but also in its analytic methods and products. Although a number of organizations and individuals currently generate high-quality evidence syntheses, potential users of the information are often frustrated by unexplained differences in the terminologies, methods, and conclusions.

“bias” refers to statistical bias, i.e., the tendency for a study to produce results that systematically depart from the truth.

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