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

Chapter: Relation of Guidelines to Review Criteria and Other Evaluation Tools

« Previous: The Committee's Definition: Practice Guideline
Suggested Citation:"Relation of Guidelines to Review Criteria and Other Evaluation Tools." Institute of Medicine. 1990. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: The National Academies Press. doi: 10.17226/1626.
Page 39

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DEFINITIONS OF KEY TERMS 39 earlier. A few areas of potential controversy can be anticipated, however, and they are discussed below. Guidelines and the Strength of Evidence In and of itself, the committee's definition of practice guidelines does not explicitly require that guidelines describe the strength of the scientific evidence or consensus associated with a set of guidelines. Rather than being part of the definition, the committee views this property as an attribute that good guidelines must have (see Chapter 3). Every set of guidelines developed or adopted by the Forum should be accompanied by clear statements about their strength, and the evidence for such statements should be cited. When the evidence is extremely strong and professional judgment is virtually unanimous, the guideline may be treated as a standard of practice permitting few if any exceptions. When the evidence is equivocal, the guideline may only identify currently acceptable practice options.2 This use of the phrases standard of practice and practice option is consistent with Eddy's usage as described earlier. However, the committee's use of the term guideline is equivalent to Eddy's umbrella use of the phrase practice policy. The committee's primary reason for using guideline as the general label was that the term is used this way in the legislation establishing AHCPR and by other sources such as the Physician Payment Review Commission. Admittedly, the committee risks creating some confusion by using the phrase standard of practice, given the OBRA 89 reference to "standards of quality," but it judges that the risk is acceptable because the term is useful and, indeed, hard to avoid. Relation of Guidelines to Review Criteria and Other Evaluation Tools In the committee's reading, OBRA 89 does not use the terms standards of quality, performance measures, and medical review criteria as synonyms for practice guidelines. Instead, it links these three terms to evaluating practice rather than to assisting practitioners and patients.3 Although the Forum is required to arrange for the development of these tools, other sponsors of guidelines may do no more than offer general observations on how the guidelines should or should not be used in evaluating practitioner decisions and outcomes. For various practical or technical reasons, some elements 2 Some health care organizations or health benefit plans may rule out certain of these options given their objectives, resource limits, or other constraints (Havighurst, forthcoming). Such decisions, however, are distinct from scientifically and professionally based judgments about practices that are acceptable options for clinicians. 3 See sections 912(a)(1) and (a)(2) of Title IX of the Public Health Service Act as amended by P.L. 101-239.

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