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

Chapter: Development Procedures and Requirements

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Suggested Citation:"Development Procedures and Requirements." Institute of Medicine. 1990. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: The National Academies Press. doi: 10.17226/1626.
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Page 26

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INTRODUCTION AND BACKGROUND 26 relevant for a variety of practitioners including physicians, nurses, nurse practitioners, and social workers. According to Forum Director Stephen King, these conditions and treatments are being considered because they are important health problems characterized by a state of clinical knowledge and professional judgment that warrants a guidelines development effort and for which guidelines can be expected to reduce inappropriate variation in services, improve the quality of care, and produce better health outcomes. Additional clinical conditions or treatments will be identified on an ongoing basis. The Forum expects to have several sets of guidelines under development or assessment at any given time. Development Procedures and Requirements The director of the Forum may contract with public and nonprofit private organizations to develop and update guidelines. The director may also convene expert panels that can either develop guidelines or review guidelines developed by contractors. (There is some disagreement about whether the legislation requires the director to use both the contracting and the panel mechanisms.) The process must include appropriate consultations with interested individuals and organizations, including general and specialty medical organizations and physicians in a variety of practice settings. In addition, the director of the Forum must establish the standards for methods and procedures to be followed by the contractors and expert panels. The legislation permits pilot-testing of the guidelines. One difficult task for the Forum has been deciding whether to convene expert panels to develop guidelines or to contract with outside entities. Initially, the Forum has adopted the first approach, namely, the convening of its own expert panels. As the guidelines program expands, the Forum may—some say, must—use the contracting mechanism. Forum staff are discussing such arrangements with a number of organizations. In addition to arranging for the development of guidelines by expert panels or contractors, the agency may adopt guidelines developed independently of the Forum if they meet the requirements established by the legislation. As described by one person involved in the drafting of OBRA 89, "This is a critical addition to the current ad hoc system. For the first time, interested parties could turn over their products to a publicly constituted, disinterested body for scrutiny. After appropriate modification, the original guidelines would achieve an imprimatur of sorts from the disinterested body" (Peter Budetti, George Washington University, personal communication, July 13, 1990).

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