Clinical Practice Guidelines: Directions for a New Program (1990)

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INTRODUCTION AND BACKGROUND 25 Deadlines and Priorities By January 1, 1991, AHCPR—acting through the Forum—must arrange for the development of an initial set of guidelines, standards, performance measures, and review criteria for at least three clinical treatments or conditions. AHCPR is also responsible for seeing that the guidelines developed under its auspices are updated. OBRA 89 created the Advisory Council for Health Care Policy, Research, and Evaluation to advise the Secretary of the Department of Health and Human Services (DHHS) and the administrator of AHCPR on priorities and strategy. It also established the Subcouncil on Outcomes and Guidelines (of the Advisory Council) to provide advice on priorities and strategy for guidelines development and outcomes research. A key explicit objective of the guidelines legislation is to help improve the quality, appropriateness, and effectiveness of health care. More implicit—yet widely recognized—is the hope that guidelines will help control health care costs. In selecting conditions for guidelines development, the agency is to consider the extent to which guidelines for the condition can be expected to reduce variations in health care services and outcomes and to improve care for significant numbers of people. Priorities for the initial sets of guidelines to be developed by January 1, 1991, are more specific and stipulate that the clinical conditions involved (1) account for significant expenditures in Medicare, (2) show significant variation in the frequency or type of treatment provided, or (3) otherwise meet the needs and priorities of the Medicare program. Target users for the guidelines, standards, review criteria, and performance measures are "physicians, health care practitioners, medical educators, medical review organizations, and consumers." At this writing, the Forum is considering initial guidelines development activities in the following areas: • Cataract surgery • Benign prostatic hyperplasia • Clinical depression • Sickle-cell disease • Management of incontinence • Management of chronic pain • Management of skin integrity and decubitus ulcers • Ambulatory care for human immunodeficiency virus infection All of these areas except ambulatory care for patients with human immunodeficiency virus had panel chairs appointed as of July 1, 1990. These areas cover a wide variety of patients (not exclusively the elderly) and are