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Suggested Citation:"PRINCIPLES." 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 55

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ATTRIBUTES OF GOOD PRACTICE GUIDELINES 55 guidelines for which the Forum has contracted. These panels will need to make both objective and subjective assessments guided by instructions from the Forum. This report is a step toward the preparation of an assessment instrument that the expert panels can use in their reviews and deliberations (Appendix C). The AMA has recently taken a similar step by developing a preliminary worksheet to evaluate what it terms practice parameters (AMA, 1990b). Third, the committee sees the initial assessment of guidelines as part of an evolutionary process of guidelines development, assessment, use, evaluation, and revision. This evolutionary process will involve the government, professional organizations, health service researchers, consumers, and others. As a result, the committee fully expects the set of attributes presented here to be tested, reassessed, and revised, if necessary. PRINCIPLES The identification of attributes of practice guidelines rests on four principles. These principles call for: • clarity in the definition of each attribute; • compatibility of each attribute and its definition with professional usage; • clear rationales or justifications for the selection of each attribute; and • sensitivity to practical issues in using the attributes to assess actual sets of practice guidelines ("accessibility"). That the definition of an attribute be clear and succinct is obviously desirable, although often difficult when one is working with very abstract or technical concepts. It is also desirable that the term used to label an attribute be recognizable and consistent with customary professional usage. The label should be a single word or short phrase that is carefully chosen to convey the core concept. (Thus, attributes will not be described by number, for example, Attribute No. 1.) The rationale or justification for each attribute should be clearly described, and it should also be consistent with the professional and technical literature and the legislative mandate. The rationale should describe explicitly any trade-offs between the theoretically ideal attribute and the practical, usable one. Practicality requires that attributes be definable in operational as well as conceptual terms; that is, it should be possible to devise an instrument that instructs assessors of a set of guidelines on how they can determine whether the guidelines conform to the attributes. Not only is this necessary if the Forum is to judge the soundness of the guidelines that emerge from

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