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ATTRIBUTES OF GOOD PRACTICE GUIDELINES 66 panel member is absent from active group discussion of the guidelines, that absence should be noted. A recent IOM workshop on group judgment noted that more research needs to be done regarding the validity and reliability of judgments reached using different group judgment techniques (IOM, 1990f; Lomas, 1990). Strength of Expert Consensus Expert groups will almost assuredly participate in the literature review and development of guidelines. The extent to which those experts agree on their findings and recommendations is important information. Thus, a set of guidelines should describe the strength and nature of the group consensus or agreement. In some cases, the experts may strongly agree that clear evidence supports precise statements in a set of guidelines about the appropriateness or inappropriateness of a particular clinical practice. This agreement is powerful support for the validity of those statements. In other situations, experts may strongly agree that no clear evidence exists on which to base precise statements about appropriateness. This, too, is important information. In still other cases, the experts may disagree about what the evidence indicates and what statements about appropriateness are warranted (Park et al., 1986). These three quite different situations have different implications for guidelines developers and users. The extent of agreement within an expert group should be reported in quantitative terms (for example, simple percentages describing levels of agreement or disagreement). When evidence or professional agreement is very strong, guidelines may be more confidently translated into criteria for evaluating practitioner performance. Independent Review In any endeavor involving expert panels and the subjective evaluation and interpretation of data, different groups may well arrive at different conclusions. Replication of guidelines development on the same clinical condition or technology is not likely to be feasible, affordable, or desirable (in terms of the opportunity costs involved). Therefore, at a minimum, some effort should be made to subject guidelines (including the relevant literature reviews) to review and criticism by professionals who are not involved in the original development process. These procedures should be described and the results summarized.
