National Academies Press: OpenBook
« Previous: Public Initiatives
Suggested Citation:"Private Initiatives." Institute of Medicine. 1990. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: The National Academies Press. doi: 10.17226/1626.
Page 23

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

INTRODUCTION AND BACKGROUND 23 Private Initiatives Guidelines for clinical practice, broadly defined, are not new. The processes of organized clinical education require various sorts of guidelines as do the processes of professional licensure, board certification, quality assurance, utilization review, and other aspects of health services administration. However, in recent years, the interest in practice guidelines of the medical community and others has grown exponentially. The level of interest in guidelines is not all that has changed. Today, there is a much greater emphasis on formal procedures and methods for arriving at a more widely scrutinized and endorsed consensus about what is appropriate clinical practice. Among the medical groups involved for some years with the development of guidelines are the American Academy of Family Physicians, the American College of Cardiology, the American College of Physicians, and the American Society of Anesthesiologists. In the research community, the RAND Corporation has pioneered the development of important tools and strategies. Newer initiatives are being undertaken or planned by the American Board of Medical Specialties, the American Medical Association, the Council of Medical Specialty Societies, and the academic medical and health services research community. Insurers, health maintenance organizations (HMOs), utilization management firms, and similar organizations have not ignored the potential of practice guidelines as a basis for refusing payment for inappropriate care. For example, several years ago the Blue Cross and Blue Shield Association began its Medical Necessity Project, which supported and cooperated with researchers and some medical organizations in their efforts to identify obsolete procedures and set guidelines for the appropriate use of many diagnostic and treatment services. The Health Insurance Association of America recently established a similar function, and the Group Health Association of America has been sponsoring programs on guidelines development. Furthermore, individual members of each of these associations are involved in additional efforts to develop or adapt practice guidelines to meet the needs of their different health plans. In addition, the activities of dozens of firms supplying utilization management services to health plan sponsors have focused attention on the quality, scope, and accessibility of the criteria they use to review care on a prospective or concurrent basis. The guidelines development efforts of private organizations are thus proceeding on many fronts. Some coordinating strategies are emerging, but important problems remain—unexplained conflicts among guidelines, neglected topics, lack of follow-up, and incomplete public disclosure of the evidence, participants, and methods used to develop sets of guidelines. There is no independent entity to certify that guidelines are sound in

Clinical Practice Guidelines: Directions for a New Program Get This Book
Buy Paperback | $50.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF
  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook,'s online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!