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CONCLUSIONS AND RECOMMENDATIONS 106 CONCLUDING COMMENTS As stated at the outset of this report, this committee believes that AHCPR's practice guidelines effort has real potential to advance the state of the art in this field, strengthen the knowledge base for health care practice, and, hence, improve the appropriateness and effectiveness of health care. The conditions for such success are demanding but not out of reach. In particular, expectations for the agencyâand for practice guidelines per seâmust be realistic regarding timetables and results. All parties concerned must act in good faith and keep the credibility and accountability of their actions in mind. Strict attention to the scientific rigor of the process is critical as is avoidance of premature closure on a single method of guidelines development. Attention to implementation and evaluation needs to be factored into the development process at an early stage. Fulfilling the agency's mission and potential will require heroic effort from a small staff, serious commitment from participants in the expert panels, and honest, practical support from the many involved and interested parties. Many conceptual and practical issues remain to be confronted. The undertaking will be strengthened if expectations are sturdily realistic, that is, neither too naively optimistic nor too cynically pessimistic.