First Name
Last Name
Email (required)
I agree to receive emails from the National Academies (required)

We respect your privacy and will never share your information.

Search this publication

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

Log In

Former MyNAP users: You'll need to reset your password on your first login to MyAcademies. Click "Forgot password" below to receive a reset link via email. Having trouble? Visit our FAQ page to contact support.

Members of the National Academy of Sciences, National Academy of Engineering, or National Academy of Medicine should log in through their respective Academy portals.

Email (required)
Password (required)

Don't have an account?

Register

Email (required)
New password (required)
Retype password (required) Password must be at least 8 characters
I agree to receive emails from the National Academies
I accept the terms of use
terms of use

Thank You

Thank you for creating a MyAcademies account!

Enjoy free access to thousands of National Academies' publications, a 10% discount off every purchase, and build your personal library.

Forgot Password

Enter the email address for your MyAcademies (formerly MyNAP) account to receive password reset instructions.

Email (required)

Reset Requested

We sent password reset instructions to your email . Follow the link in that email to create a new password. Didn't receive it? Check your spam folder or contact us for assistance.

Reset Password

New password (required)
Retype password (required) Password must be at least 8 characters

Reset Password

Your password has been reset.

Verify email

Verify Your Email Address

We sent a verification link to your email. Please check your inbox (and spam folder) and follow the link to verify your email address. If you did not receive the email, you can request a new verification link below

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

Chapter: Burden of Suffering

My Academies

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

Chapter: Burden of Suffering