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Front Matter i-viii
Summary 1-1
CONTEXT 2-2
Public Initiatives 3-4
Private Initiatives 5-5
State of the Art 6-6
Roles of Public and Private Sectors 7-7
RECOMMENDATIONS: DEFINITIONS 8-8
RECOMMENDATIONS: ATTRIBUTES OF GOOD GUIDELINES 9-11
RECOMMENDATIONS: IMPLEMENTATION AND EVALUATION 12-13
DIVERSITY IN CLINICAL PRACTICES AND GUIDELINES 14-14
EXPECTATIONS FOR PRACTICE GUIDELINES 15-16
NEXT STEPS FOR THE INSTITUTE OF MEDICINE 17-17
FINAL COMMENT 18-18
1 Introduction and Background 19-19
CONTEXT 20-20
OVERVIEW OF PRACTICE GUIDELINES INITIATIVES 21-21
Public Initiatives 22-22
Private Initiatives 23-23
SPECIFIC RESPONSIBILITIES OF AHCPR 24-24
Deadlines and Priorities 25-25
Development Procedures and Requirements 26-26
Evaluation and Further Research 27-27
OVERVIEW OF THE REPORT 28-28
CONCLUSIONS AND CAUTIONARY NOTES 29-30
REFERENCES 31-32
2 Definitions of Key Terms 33-33
THE COMMITTEE'S APPROACH 34-35
Professional and Technical Usage 36-37
The Committee's Definition: Practice Guideline 38-38
Relation of Guidelines to Review Criteria and Other Evaluation Tools 39-39
Definition of Appropriate Care 40-40
EVALUATION INSTRUMENTS 41-41
Common Usage: The Dictionary 42-42
Professional and Technical Usage 43-43
The Committee's Definition: Medical Review Criteria 44-44
Common Usage: The Dictionary 45-45
Professional and Technical Usage 46-46
The Committee's Definition: Standards of Quality 47-47
Professional and Technical Usage 48-48
CONCLUSIONS AND SUMMARY 49-49
REFERENCES 50-51
3 Attributes of Good Practice Guidelines 52-52
BACKGROUND AND TERMINOLOGY 53-53
WORKING ASSUMPTIONS 54-54
PRINCIPLES 55-55
PAST WORK ON DEFINING ATTRIBUTES 56-56
ATTRIBUTES FOR ASSESSING PRACTICE GUIDELINES: OVERVIEW 57-57
VALIDITY 58-59
Projected Health Outcomes 60-61
Projected Costs 62-62
Preference for Empirical Evidence Over Expert Judgement 63-63
Methods Used to Evaluate the Scientific Literature 64-64
Use of Expert Judgment 65-65
Independent Review 66-66
RELIABILITY/REPRODUCIBILITY 67-67
CLINICAL APPLICABILITY 68-68
CLARITY 69-69
MULTIDISCIPLINARY PROCESS 70-72
SCHEDULED REVIEW 73-73
DOCUMENTATION 74-74
CONCLUSION 75-75
REFERENCES 76-77
4 Implementation and Evaluation 78-78
Program Implementation 79-79
Government Responsibilities for Implementing Guidelines 80-80
LINKS BETWEEN DEVELOPMENT AND IMPLEMENTATION STAGES 81-81
PLANNING FOR IMPLEMENTATION 82-82
Formatting 83-84
Dissemination 85-86
Application and Administration of Guidelines 87-87
Review Organizations 88-88
Other Organizations 89-89
Updating and Revising 90-90
EVALUATION OF GUIDELINES 91-92
CONCLUSION 93-93
REFERENCES 94-95
5 Conclusions and Recommendations 96-96
Ahcpr and the Forum 97-97
Roles of Public and Private Sectors 98-98
RECOMMENDATIONS: DEFINITIONS 99-99
RECOMMENDATIONS: ATTRIBUTES OF GOOD GUIDELINES 100-100
RECOMMENDATIONS: IMPLEMENTATION AND EVALUATION 101-103
DIVERSITY IN CLINICAL PRACTICES AND GUIDELINES 104-105
CONCLUDING COMMENTS 106-106
Appendix A The Omnibus Budget Reconciliation Act of 1989 107-127
Appendix B Examples of Practice Guidelines 128-128
Screening for Breast Cancer 129-129
Burden of Suffering 130-130
Efficacy of Screening Tests 131-132
Effectiveness of Early Detection 133-134
Recommendations of Others 135-135
Discussion 136-136
REFERENCES 137-140
Screening for Breast Cancer 141-141
American College of Physicians 142-142
Screening for Breast Cancer 143-145
Dysuria Algorithm 146-147
Acute Dysuria in the Adult Female 148-148
Appendix C Next Steps for the Institute of Medicine 149-150
Appendix D Biographies of Committee Members 151-160

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

Chapter: CONCLUDING COMMENTS

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

Chapter: CONCLUDING COMMENTS