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CONCLUSIONS AND RECOMMENDATIONS 98 describe a precise course of action for the agency. The committee expects that the agency will need time to devise and revise practical, defensible approaches to guidelines development. Second, given that both the function and the organizational units (particularly the Forum) are new to the Department of Health and Human Services, the legislative timetables for guidelines development and, particularly, evaluation are unrealistically short. Moreover, the Forum has few staff to support the new functions, and this is not likely to change in the near term. In the immediate future, these constraints and complications are facts of life; the agency is acting to meet its deadlines in as timely and meaningful a way as possible. Over the longer run, however, the committee hopes that experience with the practicalities of guidelines development will lead Congress and the agency to moderate the development and evaluation timetables or to expand the resources devoted to the tasks, or both. Third, within the government, meeting the challenge of developing good practice guidelines cannot be solely the responsibility of the Forum. Other parts of AHCPR, for instance, its Medical Treatment Effectiveness Program (MEDTEP), will surely generate information of immediate importance for practice guidelines. Moreover, the exchange of information among units of government is a two-way process; lacunae in data identified during the guidelines development process should highlight areas that AHCPR can target for research funding. Outside AHCPR, the work of other agencies in the Public Health Service, most notably the National Institutes of Health's randomized controlled trials, will be essential to the long-term utility of guidelines, especially insofar as those trials include broad measures of outcomes important to patients. The agency also needs to maintain close links with HCFA, in part because of certain provisions of OBRA 89 but more importantly because HCFA has data on the Medicare population (and, to a lesser extent, on the Medicaid population) that should be of value in developing, implementing, and evaluating guidelines. Roles of Public and Private Sectors Despite the focus of this study on advice to a federal agency, the committee believes that the government's role in arranging for the development of practice guidelines may in the end be fairly modest. The contemporaneous efforts of many different organizations in the private sector may significantly outpace what AHCPR can do. This should be even more true for guidelines implementation, where most initiative must rest with private organizations and individuals. Even when the government does play the principal role in funding and disseminating guidelines on certain topics or clinical conditions, guidelines will be tailored or adjusted by providers, health plans, and others to reflect different patient populations, delivery
