Clinical practice guidelines: directions for a new program by Jerome H. Grossman, Marilyn Jane Field, Kathleen N. Lohr,

By Jerome H. Grossman, Marilyn Jane Field, Kathleen N. Lohr, Institute of Medicine (U.S.). Committee to Advise the Public Health Service on Clinical Practice Guidelines

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One difficult task for the Forum has been deciding whether to convene expert panels to develop guidelines or to contract with outside entities. Initially, the Forum has adopted the first approach, namely, the convening of its own expert panels. As the guidelines program expands, the Forum may—some say, must—use the contracting mechanism. Forum staff are discussing such arrangements with a number of organizations. In addition to arranging for the development of guidelines by expert panels or contractors, the agency may adopt guidelines developed independently of the Forum if they meet the requirements established by the legislation.

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Practice guidelines assist patients and practitioners in making decisions about health care. To that end, they describe clearly appropriate care, clearly inappropriate care, or care about which the scientific evidence and consensus are equivocal. 1 They should be developed in a formal, systematic way that is fully documented, as discussed in Chapter 3 of this report. As defined here, practice guidelines include such varied means of assisting clinical decisionmaking as pathway guidelines or practice algorithms, boundary guidelines or appropriateness criteria, and practice parameters.

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