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SUMMARY 6 independent entity exists to certify that guidelines are sound in method and content, and no "national bureau of standards" is available to set standards for methods of guidelines development or their content. The legislation creating AHCPR is one response to some of these problems. INSTITUTE OF MEDICINE COMMITTEE AND PROJECT The major immediate goal of this project was to help the Forum prepare to work with contractors or expert panels to meet its January 1991 deadline for developing at least three sets of guidelines. This assistance is also meant to help the Forum assess the soundness of the products (the guidelines) emerging from these contractors or panels. A second IOM project, described at the end of this summary, will develop a practical evaluation instrument for this purpose. To conduct the study requested by AHCPR, the IOM appointed a committee of experts in January 1990 that met in February and again in April. The committee included practicing physicians, individuals experienced in the development of guidelines, current and potential users of guidelines, and representatives of relevant other disciplines such as nursing, law, and economics. Staff from the Forum attended both committee meetings and received copies of all draft and background materials prepared for the committee. FINDINGS AND CONCLUSIONS State of the Art The committee arrived at several general observations about the state of the art of practice guidelines development. Most generally, the process of systematic development, implementation, and evaluation of practice guidelines based on rigorous clinical research and soundly generated professional consensus, although progressing, has deficiencies in method, scope, and substance. Conflicts in terminology and technique characterize the field; they are notable for the confusion they create and for what they reflect about differences in values, experiences, and interests among different parties. Public and private development activities are multiplying, but the means for coordinating these efforts to resolve inconsistencies, fill in gaps, track applications and results, and assess the soundness of particular guidelines are limited. Disproportionately more attention is paid to developing guidelines than to implementing or evaluating them. Moreover, efforts to develop guidelines are necessarily constrained by inadequacies in the quality and quantity of scientific evidence on the effectiveness of many services.