Linking evaluation and program development. The case of AHCPR-supported clinical practice guidelines

Within a research organization such as the Agency for Health Care Policy and Research (AHCPR), the process of evaluating program performance must often be integrated with a larger research and development agenda. The blending of evaluation and program development (research and development activities undertaken to build expertise and knowledge in a specific programmatic area) can both strengthen the quality of a program and enhance the science of evaluation research. This article describes AHCPR's evaluation strategy and highlights evaluation activities for the agency's clinical practice guideline program. A case study is presented to illustrate the unique methodological challenges in guideline evaluation, the creation of new tools and approaches for evaluating clinical quality, and the benefits of linking evaluation research with program development.