National Academies Press: OpenBook

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

Chapter: Program Implementation

« Previous: 4 Implementation and Evaluation
Suggested Citation:"Program Implementation." Institute of Medicine. 1990. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: The National Academies Press. doi: 10.17226/1626.
×
Page 79

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

IMPLEMENTATION AND EVALUATION 79 implementation processes needs to be anticipated as guidelines are first disseminated, used, and evaluated. • Sixth, implementation processes will not be static but will evolve as better methods are identified and less successful approaches are discarded. Such evolution may complicate evaluation. The rest of this chapter emphasizes practice guidelines and makes only occasional comments about medical review criteria, performance measures, and standards of quality. Implementation is discussed first, followed by a shorter section on evaluation. TYPES OF IMPLEMENTATION Implementation refers to the concrete activities and interventions undertaken to turn policy objectives into desired outcomes (Pressman and Wildavsky, 1973). In the context of this report, these activities are viewed as a set of partly coordinated, partly disjointed steps or activities that include formatting, disseminating, applying, and revising or updating guidelines. Two overlapping but distinct implementation tasks can be distinguished. One is implementing the public program established by OBRA 89. The other is implementing the practice guidelines themselves. Program Implementation OBRA 89 gives primary responsibility for establishing a program to develop and promote practice guidelines to the Department of Health and Human Services (DHHS) through AHCPR and its Forum. Necessary steps for implementing this program include hiring staff, developing a program agenda, establishing an advisory council, letting contracts, convening expert panels, and generally establishing and administering a broad, ongoing federal program.1 The IOM committee's advice about definitions and attributes of guidelines is intended to assist the agency with two aspects of program implementation: working with expert panels and assessing the results. Congress provided for an Advisory Council for Health Care Policy, Research, and Evaluation to advise the Secretary and the administrator of AHCPR on a broad array of activities. Council advice on the development of guidelines and the conduct of outcomes research must be handled by a special Subcouncil on Outcomes and Guidelines. Neither the Council 1 Private organizations, such as the American College of Physicians (ACP) and others that develop guidelines, face program implementation tasks that are similar in many respects to those faced by the Forum (ACP, 1986). The same statement applies to guidelines implementation.

Next: Government Responsibilities for Implementing Guidelines »
Clinical Practice Guidelines: Directions for a New Program Get This Book
×
Buy Paperback | $50.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF
  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!