Guidelines for the clinical practice of medicine have been proposed as the solution to the whole range of current health care problems. This new book presents the first balanced and highly practical view of guidelines--their strengths, their limitations, and how they can be used most effectively to benefit health care.

The volume offers

• Recommendations and a proposed framework for strengthening development and use of guidelines.
• Numerous examples of guidelines.
• A ready-to-use instrument for assessing the soundness of guidelines.
• Six case studies exploring issues involved when practitioners use guidelines on a daily basis.

Contents

• COMMITTEE ON CLINICAL PRACTICE GUIDELINES
• Acknowledgments
• Summary
• 1. Introduction
  • PURPOSE OF THE REPORT
  • WHAT ARE PRACTICE GUIDELINES?
  • WHY ARE POLICY MAKERS INTERESTED IN GUIDELINES?
  • WHO USES GUIDELINES AND FOR WHAT?
  • BASIC PROPOSITIONS
  • REPORT ORGANIZATION
  • SUMMARY
• 2. Developing Clinical Practice Guidelines
  • PLURALISM AND DIVERSITY IN GUIDELINES DEVELOPMENT
  • PROFESSIONAL SOCIETIES AND RELATED ENTITIES
  • PUBLIC AGENCIES
  • PRIVATE RESEARCH, PAYER, PROVIDER, AND OTHER GROUPS
  • COSTS OF GUIDELINES DEVELOPMENT
  • SUMMARY
• 3. Implementing Guidelines: Overview and Illustrative Cases
  • GUIDELINES AND THE REAL WORLD
  • CASE STUDIES
  • GENERAL ISSUES IN IMPLEMENTATION
  • SUMMARY
• 4. Implementing Guidelines: Conditions and Strategies
  • CONTEXT, PHILOSOPHIES, AND STRATEGIES
  • EDUCATION
  • INFORMATION AND DECISION SUPPORT SYSTEMS
  • SUMMARY
• 5. Implementation: Quality, Cost, and Risk Management
  • QUALITY ASSURANCE AND IMPROVEMENT
  • COST MANAGEMENT
  • RISK MANAGEMENT, MEDICAL LIABILITY, AND PRACTICE GUIDELINES
  • SUMMARY
• 6. The Inescapable Complexity of Decision making: Ethics, Costs, and Informed Choices
  • AN ETHICAL CONTEXT
  • GUIDELINES, COSTS, AND DECISIONS
  • THE PATIENT AS DECISION MAKER: WHAT IS INFORMED CHOICE?
  • THE PHYSICIAN AS DECISION MAKER: WHAT CARE IS REQUIRED?
  • SUMMARY
• 7. Evolution in Procedures and Methods for Developing Practice Guidelines
  • GENERAL STRUCTURES AND PROCEDURES
  • PERSISTENT QUESTIONS FOR THE DEVELOPMENT PROCESS
  • AREAS FOR METHODS RESEARCH AND DEVELOPMENT
  • ISSUES AT THE INTERFACE OF DEVELOPMENT AND IMPLEMENTATION
  • SUMMARY
• 8. A Framework for the Future
  • WORKING ASSUMPTIONS AND PRINCIPLES
  • GENERAL STRENGTHS AND WEAKNESSES OF CURRENT PRACTICE GUIDELINES ACTIVITIES
  • IMPROVING THE DEVELOPMENT OF GUIDELINES
  • ENSURING THE USE OF GOOD GUIDELINES
  • A CRITICAL NEED: MEANS TO ASSESS THE SOUNDNESS OF GUIDELINES
  • RESEARCH AGENDA
  • FINAL NOTE: GUIDELINES AND HEALTH CARE REFORM
• References
• APPENDIXES
  • A Examples of Clinical Practice Guidelines and Related Materials
  • B A Provisional Instrument for Assessing Clinical Practice Guidelines
  • C Institute of Medicine Committee on Clinical Practice Guidelines

Support for this project was provided by the John A. Hartford Foundation of New York City and by the Agency for Policy and Research, U.S. Department of Health and Human Services, under Contract No. 282-90-0018. Additional funds were provided by the Blue Cross and Blue Shield Association, CIGNA Foundation, the Prudential Foundation, and the American College of Cardiology. The views presented are those of the Institute of Medicine Committee on Clinical Practice Guidelines and are not necessarily those of the funding organizations.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.