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ATTRIBUTES OF GOOD PRACTICE GUIDELINES 75 CONCLUSION This chapter has proposed eight attributes of practice guidelines that the Forum should employ in advising its contractors and expert panels and in assessing the quality of the guidelines it receives. The attributes are validity, reliability (reproducibility), clinical applicability, clinical flexibility, clarity, multidisciplinary process, scheduled review, and documentation. Definitions of these terms and some examples that may aid in their operationalization are also given. Operationalization, that is, turning these eight concepts into a practical instrument for the Forum to use in prospectively assessing guidelines, is one task in a broader project that the IOM is currently conducting (Appendix C). Several issues about guidelines development need to be kept in mind as the Forum proceeds. First, neither existing guidelines nor those likely to be developed by the agency in the foreseeable future will "score well" on all eight properties simultaneously; indeed, near-perfect scores may always Attribute Item Clinical applicability Specification by age, sex, race, clinical diagnosis, and other factors of the populations to which a set of guidelines apply. Description and analysis of the scientific literature or expert consensus that forms the basis for statements about the age, sex, and other factors of the populations to which a set of guidelines apply. Clinical flexibility Description and analysis of the scientific literature or expert consensus that forms the basis for statements about major foreseeable exceptions to application of the guidelines. Listing of the basic information to be provided to patients and the kinds of patient preferences that may be appropriately considered. Listing of the data needed to document exceptions based on clinical circumstances, patient preferences, or delivery system characteristics. Clarity Methods and results of any testing of readability, logic, or understanding. Multidisciplinary process Description of the parties involved in developing the guidelines, their credentials and interests, and the methods used to solicit their views or to arrive at group judgments. Description of the procedures used to subject guidelines to review and criticism by experts not involved in the original development process, with summary of results. Scheduled review Timetable and method for the scheduled review. Description of the basis for arriving at the timetable or specific date.