text. Appendix A provides 16 diverse examples of guidelines and related materials. Appendix B presents a provisional instrument for assessing practice guidelines, a document that was reviewed independently of the report according to NRC procedures. Appendix C presents rosters of the committees and panels involved with or contributing to this study.

The recent surge of interest in clinical practice guidelines was born of frustration about seemingly uncontrollable increases in health care expenditures combined with grave doubts about the real value of that increased spending. Very high expectations for what guidelines might do to control costs and improve the value or quality of care are, however, giving way to a more pragmatic appreciation of the potential and limitations of guidelines.

The challenge to this committee was to provide a constructive analysis of current efforts to develop, use, and evaluate guidelines and to propose a framework for the future that offers realistic potential for improving the caliber and effectiveness of these efforts. This chapter has provided definitions and a context for the description, analysis, and recommendations that follow.