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

Chapter: The Committee's Definition: Practice Guideline

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Suggested Citation:"The Committee's Definition: Practice Guideline." Institute of Medicine. 1990. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: The National Academies Press. doi: 10.17226/1626.
Page 38

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DEFINITIONS OF KEY TERMS 38 The Committee's Definition: Practice Guideline Practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Practice guidelines assist patients and practitioners in making decisions about health care. To that end, they describe clearly appropriate care, clearly inappropriate care, or care about which the scientific evidence and consensus are equivocal. Guidelines focus on specific clinical circumstances, which may sometimes include clinically relevant organizational factors, community characteristics, social variables, and similar influences on health care delivery.1 They should be developed in a formal, systematic way that is fully documented, as discussed in Chapter 3 of this report. As defined here, practice guidelines include such varied means of assisting clinical decisionmaking as pathway guidelines or practice algorithms, boundary guidelines or appropriateness criteria, and practice parameters. (Appendix B contains examples of different styles of guidelines.) The choice of approach in developing guidelines will depend on their purpose, the intended users and sites of care, and the clarity and quality of the scientific evidence on which they are based. Judged in terms of the principles the committee set forth for good definitions, this definition is reasonably succinct, generally consistent with common, professional, and legislative usage, and not tautological. The element of advice or counsel in the committee definition differentiates guideline from such terms as suggestion (which is weaker than advice or counsel), information (which is less goal oriented), and criterion (which, as discussed below, adds the element of evaluation). The definition goes beyond the dictionary by adding the requirement that the advice or counsel be "systematically developed." This element is mentioned by many health care researchers and medical organizations either explicitly or implicitly through such phrases as "formal development" and "well understood" and references to the scientific literature. Based on its discussions in meetings and in other quarters, the committee believes its definition of practice guideline is, for the most part, practically and symbolically acceptable to varied groups. When combined with the other definitions offered here and the specification of desirable attributes of guidelines, the definition should be as little subject to misuse and misunderstanding as is possible, given the semantic diversity described 1 Clinically relevant organizational factors include the equipment, facilities, personnel, and skill levels available within a particular health care institution or local community. Clinically relevant social factors include the patient's home and family circumstances.

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