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INTRODUCTION AND BACKGROUND 28 THE INSTITUTE OF MEDICINE COMMITTEE AND PROJECT To conduct the study requested by AHCPR, the IOM appointed a committee of experts in January 1990 (Appendix D). Members were selected on the basis of their expertise and familiarity with characteristics and uses of medical practice guidelines, desirable properties or attributes of guidelines, and technical methods for preparing them. The committee included practicing physicians, individuals experienced in the development of guidelines, current and potential users of guidelines, and representatives of relevant other disciplines such as nursing, law, and economics. The IOM organized and conducted two meetings of the committee, one in February and the other in April 1990. A major immediate goal of the group was to help the Forum prepare to award and administer contracts for the development of guidelines for three clinical treatments or conditions. IOM staff provided background materials for the study committee that included a survey of guidelines activity (Audet and Greenfield, 1989), a case study of the mammography screening guideline for women aged 40 to 49 (Field, 1989), a chapter on attributes of quality of care indicators from an earlier IOM report (IOM, 1990), selected journal articles, reports from the American Medical Association and other medical organizations, and two volumes of examples of guidelines and formats from various sources. The committee also received status reports from the Forum director at each meeting. The April meeting included presentations by Mark Chassin and Sheldon Greenfield on practical implementation and evaluation issues. Chapters 2, 3, and 4 describe sources of information in more detail. In addition, IOM staff prepared papers for review by the committee as a basis for recommendations and the final report. Staff from the Forum attended both meetings and received copies of all draft and background materials prepared for the committee. After each meeting, IOM staff prepared meeting summaries and circulated them to committee members for their review and comment. Based on committee discussion of staff papers and the meeting summaries, this report was drafted, circulated to the committee for comment, revised, and then submitted for review in accordance with IOM and National Research Council report review policies. After revisions were made based on the latter review, this document was produced, constituting the committee's final report. OVERVIEW OF THE REPORT The next chapter discusses definitions of key termsâwhy the definitions are needed, how the committee approached this task, and what the literature says about terminology. It sets forth specific definitions for
