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INTRODUCTION AND BACKGROUND 27 Dissemination The responsibilities of the Forum extend beyond the development of guidelines to their dissemination. The legislation specifies that the director of the Forum shall promote the dissemination of guidelines through organizations representing health care providers and health care consumers, peer review organizations, accrediting bodies, and other appropriate entities. In addition, the guidelines must be presented in formats appropriate for use by practitioners, medical educators, and medical care reviewers. Among the first steps the agency is taking to promote the dissemination of guidelines is to work with the National Library of Medicine for inclusion of the guidelines in the library's various information systems. Use of Guidelines The legislation establishing AHCPR and the Forum states that the Secretary of Health and Human Services "shall provide for the use of the [initial sets of] guidelines. . .to improve the quality, effectiveness, and appropriateness of care" provided under the Medicare program. No further details are offered. Presumably, providing for the use of the guidelines will require that HCFA and its contracting fiscal intermediaries, carriers, and peer review organizations take steps to incorporate medical review criteria and other evaluation instruments into their programs to review care provided to Medicare beneficiaries. Discussion of these matters is at the most preliminary stages within DHHS. Evaluation and Further Research The Secretary of Health and Human Services must determine the impact of the initial set of guidelines on the cost, quality, appropriateness, and effectiveness of health care and report these findings to Congress by January 1, 1993. Because an adequate evaluation within this time period is virtually impossible (see Chapter 4), the agency expects to provide Congress with a status report at the start of 1993 rather than a complete evaluation. More generally, the director of the Forum is to conduct and support evaluations of the impact of guidelines on clinical practice. In addition, the director is to recommend research projects to the AHCPR administrator that are related to (1) evaluating outcomes of health care services and procedures, (2) developing standards and criteria for the guidelines development process (what are called "attributes" in this report), and (3) promoting the use of the guidelines, standards, performance measures, and review criteria developed under the Forum's auspices.
