Clinical Practice Guidelines: Directions for a New Program (1990)

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CONCLUSIONS AND RECOMMENDATIONS 100 levels of practice guidelines (for example, Level 1 or Level 2 guidelines), although this may be useful. For now, the committee recommends that every set of guidelines describe the strength of the evidence and consensus so that potential users can make more informed decisions. RECOMMENDATIONS: ATTRIBUTES OF GOOD GUIDELINES In proposing attributes of good guidelines, the committee tried to define properties or characteristics that would be compatible with professional use and legislative expectations; clearly defined and justified; and demanding but realistically approachable. Prospective assessments of the guidelines (rather than evaluations of their ultimate impact) should use the attributes as benchmarks for judging the soundness of the guidelines. The focus should be on guidelines as a set rather than as isolated statements. Creating a practical assessment instrument for AHCPR, based on the attributes below, is one task of a second IOM project on practice guidelines (Appendix C). In this first project, the committee has tried to be sensitive to the challenges involved in moving from abstract concepts to real applications. The committee recommends that the agency look for the following eight attributes, properties, or characteristics when it assesses the soundness of guidelines. Relatedly, the agency should instruct its contractors and expert panels to adhere to procedures that will produce guidelines in keeping with these attributes. VALIDITY: Practice guidelines are valid if, when followed, they lead to the health and cost outcomes projected for them, other things being equal. A prospective assessment of validity will consider the projected health outcomes and costs of alternative courses of action, the relationship between the evidence and recommendations, the substance and quality of the scientific and clinical evidence cited, and the means used to evaluate the evidence. RELIABILITY/REPRODUCIBILITY: Practice guidelines are reliable and reproducible (1) if—given the same evidence and methods for guidelines development—another set of experts would produce essentially the same statements and (2) if—given the same circumstances—the guidelines are interpreted and applied consistently by practitioners or other appropriate parties. A prospective assessment of reliability may consider the results of independent external reviews and pretests of the guidelines. CLINICAL APPLICABILITY: Practice guidelines should be as inclusive of appropriately defined patient populations as scientific and clinical evidence