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SUMMARY 7 Ahcpr and the Forum As a consequence of the above factors, AHCPR and the Forum have, at present, a somewhat restricted foundation for their work. In addition, at least three other variables must be taken into account in estimating what the agency is likely to be able to accomplish early in its guidelines effort. First, although OBRA 89 addresses some concerns about guidelines development, implementation, and evaluation, it appropriately does not describe a precise course of action. The agency will need time to devise and revise practical and defensible approaches to guidelines development. Second, given that both the function and the organizational units (particularly the Forum) are new to the Department of Health and Human Services, the legislative timetables for guidelines development and, particularly, evaluation are unrealistically short. Moreover, the Forum has few staff to support the new functions, a deficit that is not likely to change in the near term. In the immediate future, these constraints and complications are facts of life; the agency is acting to meet its deadlines in as timely and meaningful a way as possible. Over the longer run, however, the committee hopes that experience with the practicalities of guidelines development will lead Congress and the agency to moderate the development and evaluation timetables or to expand the resources devoted to the tasks, or both. Third, within the government, meeting the challenge of developing good practice guidelines cannot be solely the responsibility of the Forum. For instance, AHCPR's Medical Treatment Effectiveness Program (MEDTEP) will generate information of immediate importance for practice guidelines. Lacunae in data identified during the guidelines development process should highlight areas that AHCPR can target for research funding. Outside AHCPR, the work of other agencies in the Public Health Service (PHS), most notably NIH's randomized controlled trials, will be essential to the long-term utility of guidelines, especially insofar as those trials include broad measures of outcomes important to patients. Outside the PHS, the agency needs to maintain close links with the Health Care Financing Administration, in part because of provisions of OBRA 89 but more importantly because HCFA's data on the Medicare population (and, to a lesser extent, on the Medicaid population) should be valuable for developing, implementing, and evaluating guidelines. Roles of Public and Private Sectors Despite the focus of this study on advice to a federal agency, the committee believes that the government's role in arranging for the development
