National Academies Press: OpenBook
« Previous: 5 Conclusions and Recommendations
Suggested Citation:"Ahcpr and the Forum." Institute of Medicine. 1990. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: The National Academies Press. doi: 10.17226/1626.
Page 97

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.

CONCLUSIONS AND RECOMMENDATIONS 97 Throughout this report, the committee has sought to emphasize basic principles that should guide the development, use, and evaluation of guidelines. In most case, it has not proposed specific techniques. The choice of techniques—for instance, how to analyze scientific literature or how to provide incentives for the use of guidelines—will depend on practical circumstances too numerous to cover comprehensively in this document. This chapter summarizes the committee's major findings and conclusions, reviews its recommendations about definitions of terms and attributes of guidelines, and outlines some of the complexities in implementing and evaluating guidelines that need to be kept in mind as guidelines are developed. The chapter closes with some observations about diversity and conflict among guidelines and the challenges facing the new agency. FINDINGS AND CONCLUSIONS State of the Art The committee arrived at several general observations about the state of the art of practice guidelines development. Most generally, the process of systematic development, implementation, and evaluation of practice guidelines based on rigorous clinical research and soundly generated professional consensus, although progressing, has deficiencies in method, scope, and substance. Conflicts in terminology and technique characterize the field and are notable not just for the confusion they create but also for what they reflect about differences in values, experiences, and interests among different parties. Public and private activities are multiplying, but the means for coordinating these efforts to resolve inconsistencies, fill in gaps, track applications and results, and assess the soundness of particular guidelines are limited. Disproportionately more attention continues to be paid to the development of guidelines than to their implementation or evaluation. Moreover, efforts to develop guidelines are necessarily constrained by inadequacies in the quality and quantity of scientific evidence on the effectiveness of many services. 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, other variables must be taken into account in estimating what the agency is likely to be able to accomplish early in its guidelines effort. Among the more important are the following. First, although OBRA 89 addresses some concerns about guidelines development, implementation, and evaluation, it appropriately does not

Next: Roles of Public and Private Sectors »
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,'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!