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ATTRIBUTES OF GOOD PRACTICE GUIDELINES 53 The next four sections review the context, working assumptions, principles, and sources that guided the committee in developing its list of attributes, followed by a discussion of the attributes themselves. This chapter, however, is not intended either as an exhaustive description of how guidelines should be developed or as an endorsement of one specific method.1 The discussion in this chapter focuses on attributes of guidelines rather than attributes of medical review criteria, standards of quality, and performance measures. The recent IOM report on quality assurance in the Medicare program (1990d) discusses some attributes that good medical review criteria should have, for example, specificity and sensitivity. One further introductory point: the committee has urged AHCPR and its Forum to focus their efforts on guidelines for clinical conditions rather than specific treatments or procedures. This focus will undoubtedly make their task more difficult: a consideration of conditions generally involves a broader look at alternatives, evidence, practice settings, and outcomes. The result, however, should be guidelines that are both more broadly and more specifically useful to clinicians and patients. The discussion of attributes in this chapter reflects this emphasis on conditions rather than procedures. BACKGROUND AND TERMINOLOGY OBRA 89 specifies that "the Director [of the Forum] shall establish standards and criteria to be utilized by the recipients of contracts" for "developing and periodically reviewing and updating" guidelines, standards, performance measures, and review criteria. Confusion is likely if "criteria and standards" are used to label both the bases for prospectively assessing practice guidelines and the bases for assessing clinician practice. Consequently, to reduce possible terminological confusion, this report refers to ''attributes of guidelines" rather than to "standards and criteria" for "guidelines, standards, performance measures, and review criteria." Synonyms include properties and characteristics. 2 The Forum must be able to employ the list of attributes set forth in this chapter in at least two ways. First, it will need to communicate its expectations in advance to the contractors or expert panels that may develop guidelines for the agency. Second, the Forum and potential users of the guidelines must be able to assess the soundness of a given set of guidelines after they are developed. The IOM expects in a second project 1 The list of works by Eddy, Gottlieb and associates, and Park and colleagues at the end of this chapter contains more detailed discussions of processes for developing guidelines. 2 This language generally follows the precedent set by the IOM report Medicare: A Strategy for Quality Assurance (1990d). It is also consistent with the booklet "Attributes to Guide the Development of Practice Parameters" (AMA, 1990a).
