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CONCLUSIONS AND RECOMMENDATIONS 96 5 Conclusions and Recommendations We would consider our effort a success if more people began with the understanding that implementation, under the best of circumstances, is exceedingly difficult. They would, therefore, be pleasantly surprised when a few good things really happened. Pressman and Wildavsky, Implementation The challenge facing AHCPR and its Forum in the area of practice guidelines is great, calling as it does for swift movement along many paths in territory that is neither well charted methodologically nor well established culturally. The challenge is intensified by the initiative's origins in the acute public and private frustration about ever-increasing health care spending for services of sometimes doubtful value. Expectations for the guidelines initiative are thus very high. In the context of current activities and hopes for practice guidelines, the basic charge to this committee was narrow: to define terms, to propose attributes of guidelines, and to explore in a preliminary way issues relating to implementation and evaluation. AHCPR needed the committee's recommendations quickly, and the project's short timetable limited its scope and depth. The statements singled out in this chapter as findings, conclusions, and recommendations are those that relate most directly to the committee's charge. Many of the broader issues related to the development, use, and evaluation of guidelines are being examined in a longer IOM project (see Appendix C).