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 81 Roles of Other Organizations in Implementing Guidelines Absent further legislation or regulations to the contrary, the federal government will not be the major actor in implementing guidelines. Rather, an array of private individuals and organizations will be the crucial participants in every stage of implementation. OBRA 89 refers explicitly to the involvement of provider and consumer organizations, medical educators, peer review organizations, and accrediting bodies in the dissemination of guidelines, but dissemination is only one step in assuring that guidelines are applied by clinicians and patients to improve health care outcomes. What goes on in delivery settings such as hospitals, physician offices, and nursing homes is the key to successful implementation. The foundation for such success, however, starts much earlier during the process of guidelines development. LINKS BETWEEN DEVELOPMENT AND IMPLEMENTATION STAGES In discussing the attributes of good guidelines in Chapter 3, the committee has underscored the link between development and implementation in several ways, including the following examples. 1. The credibility of the development process, the participants, and the scientific grounding of guidelines must be clear to intended users. 2. A truly multidisciplinary approach to guidelines development will facilitate acceptance and use of guidelines by members of the groups represented and by other, secondary groups. 3. Guidelines should be specific, comprehensive, and flexible enough to be useful in the varied settings and circumstances of everyday medical practice and in the evolving programs to assess the appropriateness of care provided in these settings. 4. Guidelines language, logic, and symbols should be easy to follow and unambiguous, so that movement from guidelines to educational tools, review criteria, or other instruments is unimpeded. 5. Pretesting is highly useful; it can be done on a pilot basis in a real delivery setting, on a set of prototypical cases, or by both methods. 6. The guidelines should specify what information about the clinical problem, the patient's circumstances and preferences, and the delivery setting should be recorded to permit later evaluation of the appropriateness of care (judged against criteria generated from the guidelines). Developers of guidelines need to be cognizant of the practical realities involved in translating guidelines into medical review criteria and applying those criteria for quality assurance and other purposes. Such foresight is important whether the processes of guidelines and criteria development