clinical and scientific evidence into the guidelines. The latter seems particularly relevant in developing clinical guidelines in the drug abuse field, if the target audience (i.e., community-based treatment programs) is to view the guidelines as credible. Multidisciplinary participation maximizes the chances for addressing practical problems in their use. A recent report recommended that guidelines be accompanied by a timetable for scheduled review and revision (IOM, 1997).
A number of studies have demonstrated that merely publishing guidelines does not change the practice patterns of targeted clinicians, but that there are strategies which enhance the likelihood of this occurring (Greco and Eisenberg, 1993; Rogers, 1995b). Strategies that work include direct endorsement by respected professional associations and clinical "opinion leaders," coupled with teaching sessions under their aegis, and the incorporation of guidelines into training and continuing education programs, as well as self-assessment, certification, and recertification examinations. The use of practice guidelines by third party payers and managed care organizations to inform decision making on benefit utilization also enhances their dissemination and ultimate acceptance. Incorporating measures of dissemination and incorporating guideline use in HEDIS surveys and JCAHO standards would facilitate this goal. It will be necessary to devise strategies by which the acceptability and ultimate utility of practice guidelines in drug and alcohol abuse treatment can be measured.
Compared to practice guidelines that have been developing for more than a decade, the science of consumer scorecards in health care is in an early state (Hanes and Greenlick, 1998). However, the movement is growing and a useful purpose could be served in the development of scorecards providing information about community-based treatment programs. Included in such scorecards would be information from consumer satisfaction and quality of life surveys, as well as other data on short- and long-term treatment outcomes assessing the effectiveness of the treatment program.
Closely linked to practice guidelines are consensus conferences and the development of evidence-based reviews, two other mechanisms that are being widely tested in other areas of the health care delivery to reduce the communication gaps among research, practice, and policy segments. The experience of the Agency for Health Care Policy Research (AHCPR) can provide some guidance in this area. As the question of practice variation and inefficiency in the health care system became a major focus at AHCPR, their first approach was the creation of a set of Patient Outcome Research Teams (PORT) and the implementation of a guidelines development process within the Agency. Several PORTs were funded, each with a focus on