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Guidelines for Clinical Practice: From Development to Use
its work would be subject to the usual vagaries of the federal appropriations process, and it would be politically vulnerable to hostile actions from organizations whose guidelines, once assessed, do not pass muster.
Other groups, such as the American Medical Association (AMA), have also offered themselves in the role of "certifier" of guidelines. The AMA, in fact, has drafted its own assessment instrument and developed a process for applying it. Nevertheless, a powerful medical organization could have its own problems of credibility in this role, no matter how well it performs. Clearly, assessment would be a sensitive undertaking when guidelines from one group in the larger association clearly conflicted with or were "prejudicial" to those of another group.
Weighing the various pluses and minuses, the committee finally concluded that an assessment entity would best be organized as a private, not for-profit organization and that it should have a governing board drawn from a wide range of interested parties, both public and private. The entity must be apart from, but able to work with, the parties that have a stake in guideline development. To forestall criticisms about objectivity and integrity, the board of any such organization would develop clear procedures regarding bias, conflicts of interest, and other issues of accountability.5
• Products and focus. The proposed assessment entity would have one primary product: periodic publication of assessments of the guidelines issued by public and private organizations. Overseeing publication of the assessments and other dissemination activities would be the responsibility of the governing board.
In terms of publications, the committee believes that a journal is an attractive option. Its articles or reports should combine the academic rigor of top professional journals with the user-oriented style of a publication like Consumer Reports. The latter journal has several attractive features.6 It compares products with a similar purpose rather than reporting on products in isolation. It uses graphics and other devices to great advantage to provide easy-to-assimilate information on the strengths, weaknesses, and characteristics of products. Further, it explicitly recognizes that consumers have different preferences and circumstances that may lead them to different choices based on individual weighing of this information.
An annual review issue might provide summary compilations of the
Such procedures would include peer review of the assessments. In addition, the entity might publish both its assessment methodology and its assessments in draft form for public review and comment. The latter would be analogous to the process by which federal regulations are published in the Federal Register for comment before final promulgation occurs. AHCPR's Patient Outcomes Research Teams, the committees of the National Academy of Sciences, and similar organizations offer other model procedures.
The committee is not recommending, however, that the assessment entity be modeled directly on Consumers Union.