(CPGs) ideally reflect this understanding when they are developed via a transparent process by a group of multidisciplinary experts (including patient representatives) screened for minimal potential bias and conflicts of interest, and supported by a systematic review of the evidence. Rather than dictating a one-size-fits-all approach to patient care, CPGs should aid clinician and patient decision making by clearly describing and appraising the evidence and reasoning regarding the likely benefits and harms related to specific clinical recommendations. This chapter provides background on the history of Institute of Medicine (IOM) involvement in issues related to CPG development, a discussion of the scope of work for this study, and a new definition for trustworthy CPGs.


The IOM’s involvement in the clinical practice guideline arena began with the Omnibus Budget Reconciliation Act of 1989,1 which created the Agency for Health Care Policy and Research (AHCPR), now known as the Agency for Healthcare Research and Quality (AHRQ), to focus on outcomes and effectiveness research. The agency was created in part due to frustrations with “ceaselessly escalating healthcare costs, wide variations in medical practice patterns, evidence that some health services are of little or no value, and claims that various kinds of financial, educational, and organizational incentives can reduce inappropriate utilization” (IOM, 1990, p. 2). A relatively small portion of the agency’s budget was dedicated to creation and update of guidelines through a public–private enterprise. The agency contracted with the IOM for expert advice on launching this function, and in 1990, the IOM’s Committee to Advise the Public Health Service on Clinical Practice Guidelines issued its report, Clinical Practice Guidelines: Directions for a New Program. In 1990, the IOM defined CPGs as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” (IOM, 1990, p. 8). The first IOM guideline committee recommended that CPGs include the following:

  • A statement about the strength of the scientific evidence and expert judgment


Omnibus Budget Reconciliation Act of 1989, Public Law 101-239, 101st Cong. (December 19, 1989).

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