Previous chapters discussed standards for trustworthy guidelines, explored methods for their development and implementation, and put forth committee recommendations. In this final chapter, the committee discusses national policy questions related to clinical practice guidelines (CPGs), such as who should develop guidelines; how CPGs that meet the proposed standards should be identified; whether there is a continuing need for the National Guideline Clearinghouse (NGC); whether there should be a process to harmonize related CPGs and identify recommendations for quality measures; and how proposed standards and impact of standards-based CPGs should be pilot-tested and evaluated. Finally, the committee makes recommendations regarding the identification and certification of trustworthy CPGs, research on harmonization of inconsistent CPGs, and evaluation of the proposed standards and the impact of trustworthy clinical practice guidelines on healthcare and patient outcomes.

Researchers have raised the possibility of centralizing development of CPGs in one federal organization (Shaneyfelt and Centor, 2009). The potential benefits from this arrangement could include reduced bias, a reduction in multiple CPGs on the same topic, and improved guidance for future research. A single organization that develops CPGs based on the proposed standards and provides assurance that all CPGs meet the standards would be efficient. Although the Agency for Healthcare Research and Quality (AHRQ) performed a guideline development function early in its history, it was not the sole producer of CPGs during that period. It was a politically difficult function for a public agency subject to congressional appropriations, and the agency has not attempted to reestablish that activity.

Throughout its study, the committee has recognized the many public and private organizations participating in clinical practice guideline development. The Institute of Medicine report, Knowing What Works, concluded that a pluralistic approach to guideline development, while not without problems, was desirable (IOM, 2008). This committee recognizes value in a diverse community of developers and the unique relationships each has with its constituency, relevant experts, practitioners, and funding sources. Many organizations have made major investments in technical staff and other resources devoted to CPG development (Coates, 2010). In addition, many have earned public trust for their efforts. Organiza-