Making clinical practice guidelines work: the experience of one home healthcare agency

Almost 20 years have passed since clinical practice guidelines were introduced into the healthcare system and they have permeated into every area of clinical practice. Originally clinical practice guidelines were regarded, by healthcare chief executive officers, as "the answer" to the need to reduce inappropriate or unnecessary variation in clinical practice. Between 1990 and 1996, the U.S. Agency for Health Care Policy and Research introduced 19 practice guidelines in an effort to support evidence-based methods to assess medical treatments and to set high standards for the development of guidelines. This article will explore the development and/or adoption and clinical application of guidelines into practice.