ment itself, in three operational parts—a general information sheet, the full instrument, and a summary evaluation sheet. The instrument is termed provisional because the committee firmly believed that more experience needs to be accumulated by testing it on different kinds of guidelines.


The central purpose of the IOM's instrument for assessing clinical practice guidelines is to provide an explicit method for examining the soundness of such guidelines and to encourage their systematic development. By assessment is meant a prospective judgment of the soundness of both the process used in developing a guideline and the resulting guideline. The intent is to avoid situations in which a guideline that is not consistent with the scientific evidence is nonetheless "rated" as good on procedural criteria alone.1

More concretely, the IOM intended to operationalize its attributes of good guidelines and to provide a standardized approach and structure for the assessment of a guideline document. The resulting form is not simple. Therefore, the IOM does not expect practicing physicians or other clinicians, patients, other nonprofessionals, or policy makers to apply this instrument. Rather it expects individuals (or groups) with three types of expertise to apply it-namely, those with clinical experience with patients who have the conditions or problems covered by the guideline document, those with research experience in the conditions or technologies covered, and those with methodologic skills in developing guidelines. Any final or overall judgments of a guideline document emerging from the application of this instrument would be reported in simpler, summary form in ways that would convey the relative soundness (or lack of it) of a given guideline document to all potential users of the guideline.

The IOM committee sees three possible uses of this instrument: as an educational tool, as a self-assessment tool, and as a means of judging guidelines before their adoption. The Agency for Health Care Policy and Research (AHCPR) may want to use this instrument, or one like it, in directing the work of its guidelines-development panels; the agency may also wish to employ it in judging the products of those panels or the guidelines developed by other groups, such as medical specialty societies. Furthermore, other groups may wish to review existing or draft guidelines of their own against this instrument, in an effort to identify guidelines warranting revision or defects in draft guidelines that warrant correction before they are put into final form. Finally, if an organization were to be created for the


Evaluation of the eventual impact of guidelines is a separate step. Both IOM reports (1990 and this one) include discussions of evaluation.

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