Clinical Practice Guidelines -- Copyright -- Acknowledgments -- Contents -- Summary -- CONTEXT -- OVERVIEW OF PRACTICE GUIDELINES INITIATIVES -- Public Initiatives -- Private Initiatives -- INSTITUTE OF MEDICINE COMMITTEE AND PROJECT -- FINDINGS AND CONCLUSIONS -- State of the Art -- Ahcpr and the Forum -- Roles of Public and Private Sectors -- RECOMMENDATIONS: DEFINITIONS -- RECOMMENDATIONS: ATTRIBUTES OF GOOD GUIDELINES -- RECOMMENDATIONS: IMPLEMENTATION AND EVALUATION -- DIVERSITY IN CLINICAL PRACTICES AND GUIDELINES -- EXPECTATIONS FOR PRACTICE GUIDELINES -- NEXT STEPS FOR THE INSTITUTE OF MEDICINE -- FINAL COMMENT -- 1 Introduction and Background -- CONTEXT -- OVERVIEW OF PRACTICE GUIDELINES INITIATIVES -- Public Initiatives -- Private Initiatives -- SPECIFIC RESPONSIBILITIES OF AHCPR -- Deadlines and Priorities -- Development Procedures and Requirements -- Dissemination -- Use of Guidelines -- Evaluation and Further Research -- THE INSTITUTE OF MEDICINE COMMITTEE AND PROJECT -- OVERVIEW OF THE REPORT -- CONCLUSIONS AND CAUTIONARY NOTES -- REFERENCES -- 2 Definitions of Key Terms -- THE COMMITTEE'S APPROACH -- PRACTICE GUIDELINES -- Common Usage: The Dictionary -- Professional and Technical Usage -- The Committee's Definition: Practice Guideline -- Guidelines and the Strength of Evidence -- Relation of Guidelines to Review Criteria and Other Evaluation Tools -- Definition of Appropriate Care -- Guidelines and Costs -- EVALUATION INSTRUMENTS -- MEDICAL REVIEW CRITERIA -- Common Usage: The Dictionary -- Professional and Technical Usage -- The Committee's Definition: Medical Review Criteria -- STANDARDS OF QUALITY -- Common Usage: The Dictionary -- Professional and Technical Usage -- The Committee's Definition: Standards of Quality -- PERFORMANCE MEASURES -- Common Usage: The Dictionary -- Professional and Technical Usage.

The Committee's Provisional Definition: Performance Measures -- CONCLUSIONS AND SUMMARY -- REFERENCES -- 3 Attributes of Good Practice Guidelines -- BACKGROUND AND TERMINOLOGY -- WORKING ASSUMPTIONS -- PRINCIPLES -- PAST WORK ON DEFINING ATTRIBUTES -- ATTRIBUTES FOR ASSESSING PRACTICE GUIDELINES: OVERVIEW -- VALIDITY -- Projected Health Outcomes -- Projected Costs -- Relationship Between the Evidence and the Guidelines -- Preference for Empirical Evidence Over Expert Judgement -- Thorough Literature Review -- Methods Used to Evaluate the Scientific Literature -- Strength of Evidence -- Use of Expert Judgment -- Strength of Expert Consensus -- Independent Review -- Pretesting -- RELIABILITY/REPRODUCIBILITY -- CLINICAL APPLICABILITY -- CLINICAL FLEXIBILITY -- CLARITY -- MULTIDISCIPLINARY PROCESS -- SCHEDULED REVIEW -- DOCUMENTATION -- CONCLUSION -- REFERENCES -- 4 Implementation and Evaluation -- TYPES OF IMPLEMENTATION -- Program Implementation -- Guidelines Implementation -- Government Responsibilities for Implementing Guidelines -- Roles of Other Organizations in Implementing Guidelines -- LINKS BETWEEN DEVELOPMENT AND IMPLEMENTATION STAGES -- PLANNING FOR IMPLEMENTATION -- ELEMENTS OF IMPLEMENTATION -- Formatting -- Dissemination -- Application and Administration of Guidelines -- Provider Organizations -- Review Organizations -- Other Organizations -- Updating and Revising -- EVALUATION OF GUIDELINES -- CONCLUSION -- REFERENCES -- 5 Conclusions and Recommendations -- FINDINGS AND CONCLUSIONS -- State of the Art -- Ahcpr and the Forum -- Roles of Public and Private Sectors -- RECOMMENDATIONS: DEFINITIONS -- RECOMMENDATIONS: ATTRIBUTES OF GOOD GUIDELINES -- RECOMMENDATIONS: IMPLEMENTATION AND EVALUATION -- DIVERSITY IN CLINICAL PRACTICES AND GUIDELINES -- CONCLUDING COMMENTS -- Appendix A The Omnibus Budget Reconciliation Act of 1989.

Appendix B Examples of Practice Guidelines -- EXAMPLE 1 REPORT OF THE U.S. PREVENTIVE SERVICES TASK FORCE -- Screening for Breast Cancer -- Burden of Suffering -- Efficacy of Screening Tests -- Effectiveness of Early Detection -- Recommendations of Others -- Discussion -- Clinical Intervention -- REFERENCES -- EXAMPLE 2 AMERICAN COLLEGE OF PHYSICIANS -- Screening for Breast Cancer -- American College of Physicians -- EXAMPLE 3 GROUP HEALTH COOPERATIVE OF PUGET SOUND, INC. -- Screening for Breast Cancer -- EXAMPLE 4 HARVARD COMMUNITY HEALTH PLAN -- Dysuria Algorithm -- Acute Dysuria in the Adult Female -- Appendix C Next Steps for the Institute of Medicine -- Appendix D Biographies of Committee Members.