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SUMMARY 1 Summary In November 1989, Congress amended the Public Health Service Act to create the Agency for Health Care Policy and Research (AHCPR). Under the terms of Public Law 101-239, this agency has broad responsibilities for supporting research, data development, and other activities that will "enhance the quality, appropriateness, and effectiveness of health care services. . . ." The needs and priorities of the Medicare program are an important but not exclusive focus of the agency. Many of AHCPR's responsibilities formerly belonged to the National Center for Health Services Research, which the agency replaced, but the emphasis on outcomes and effectiveness research is now considerably stronger. Other functions of the agency are new, in particular those involving a joint public-private enterprise to develop, disseminate, and evaluate practice guidelines under the sponsorship of the agency's Forum for Quality and Effectiveness in Health Care. Shortly after its creation, AHCPR requested advice from the Institute of Medicine (IOM) on how it might approach these new responsibilities for practice guidelines. The IOM agreed to appoint a study committee that would work quickly to provide technical assistance and advice on definition of terms, specification of key attributes of good guidelines, and certain aspects of planning for implementation and evaluation. This report largely confines itself to these fairly specific and limited tasks. It is not a how-to-do-it manual, a methodology text, a priority-setting exercise, or a primer on guidelines for those seeking an introduction to the subject. The report does, however, aim to encourage more standardization and consistency in