Reasonable expectations: from the Institute of Medicine. Interview by Paul M. Schyve

When the Omnibus Budget Reconciliation Act of 1989 created a new agency in the U.S. Public Health Service to foster the development of practice guidelines and outcomes and effectiveness research, the Institute of Medicine was engaged to develop the criteria for guideline development and medical review. The new agency--the Agency for Health Care Policy and Research (AHCPR)--has used those criteria to develop and disseminate its first three commissioned guidelines, released this spring. Those criteria are elaborated in the IOM's 1990 book. In a second book, released this summer, the IOM Committee on Clinical Practice Guidelines reviews the constructive expectations for guidelines and the conditions needed to ensure rigor in their development, application, evaluation, and revision to help realize these expectations. Key recommendations for action are development of an instrument to assess guidelines and establishment of an organization to carry out the assessment of guidelines. In an appendix, the report offers "A Provisional Instrument for Assessing Clinical Practice Guidelines." While asking that organizations undertake more field testing and revision of the instrument, the Committee on Clinical Practice Guidelines believes that the provisional instrument will be useful as an educational tool for those beginning to develop guidelines, a self-assessment tool that developers of guidelines can use to check their work, and a tool for external groups to use in judging whether a set of guidelines should or should not be recommended or adopted.