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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 techniquesâfor instance, how to analyze scientific literature or how to provide incentives for the use of guidelinesâwill 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