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Appendix C Next Steps for the Institute of Medicine In May 1990, a new committee of the Institute of Medicine (IOM) began an Month study of the development, implementation, evaluation, and revision of clinical practice guidelines. The report will cover both public- and pnvate-sector activities. Many of the issues raised by the IOM Committee to Advise the Public Health Service on Clinical Practice Guidelines will be examined in depth during this second project. In preparing its report and recommendations, the new committee will . describe existing initiatives to develop, implement, and evaluate practice guidelines; identify the strengths and limitations of these efforts ~ light of the objectives and concerns of specific interest groups and society in general; o describe different models of public and private action that might serve as prototypes for better structuring activities related to guidelines; . analyze and assess the strengths, wealmesses, uncertainties, arid trade-offs of different models in responding to identified problems and objectives; and . propose a framework for better structuring the development, im- plementation, evaluation, and revision of practice guidelines. In addition, the committee will propose a practical methodology for AHCPR and others to employ in assessing guidelines before recommending or using them. This methodology will focus on the process by which the guidelines were developed, their scientific basis, their relevance to clinical 149

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150 CONICAL PRACTICE GUIDELINES practice, their Claris, and other characteristics. Such initial assessments will not substitute for later evaluations by government and others of the impact of guidelines. I-he committee's recommendations will identify legislative, manage- ment, and other steps necessary to implement the recommendations. That is, the design plan will propose, insofar as possible, both what to do and how to do it. An active program of disseminating the committee's findings and recommendations is planned. This next project on practice guidelines is supported by grants from the John ~ Hartford Foundation, Inc., and the Public Health Service. The committee is chaired by Jerome H. Grossman, and the study director is Marilyn J. Field. The report should be released in the fall of 1991.