TABLE C-1 Examples of Tools for Measuring the Quality of Clinical Practice Guidelines Development




A Provisional Instrument for Assessing Clinical Practice Guidelines

To provide an explicit method for examining the soundness of clinical practice guidelines (CPGs) and to encourage their systematic development. The committee developed this instrument to be used as an education tool, a self-assessment tool, or a means of judging guidelines before their adoption.

Each of the tool’s seven attributes subsumes a number of dimensions. Each dimension is assigned a “yes/no” score (the dimension is or is not represented in the guideline). If yes, an associated rating of satisfactory, conditionally satisfactory, or unsatisfactory (degree to which the dimension is satisfied) is given. If the dimension is not represented (i.e., “no” response), then a judgment of whether the omission is unimportant, minor, or major is made. If most responses to the questions are “satisfactory” (or “unimportant omissions”), one might reasonably conclude that such a guideline would be sufficient for most clinical situations. Alternatively, if most responses were unsatisfactory (or major omissions), one would probably argue that the guideline needed to be revised before it could be used effectively.

IOM (1992)



The seven attributes include



  1. Clinical applicability

    1. The guideline document describes the patient populations to which the guidelines are meant to apply.

    2. The guideline document discusses complex clinical problems for the population(s) covered by the guidelines.

    3. The guideline document gives a rationale for excluding patient population(s).

  2. Clinical flexibility

    1. The guideline document provides specific information about situations in which clinical exceptions might be made in applying the guidelines.

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