Clinical practice guidelines: Opportunities and implications

Clinical practice guidelines have been defined as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. They are intended to improve the quality, appropriateness, and effectiveness of care. While particular guidelines may be challenged on the grounds that they are not inclusive of all effective treatment strategies or are too difficult ol too expensive to implement, there is evidence that guidelines can influence clinical decision-making in ways that improve treatment outcomes and sometimes also in ways that reduce costs. Guidelines are viewed by policymakers as an important factor in rational decision-making about payment practices and other policy issues, but they can provoke controversies among providers and researchers. This article gives a broad overview of practice guidelines from a health policy perspective. Strategies for guideline development are described, with a focus on guidelines developed by the Agency for Health Care Policy and Research, the U.S. Clinical Preventive Services Task Force, and managed care organizations. Issues related to implementation of guidelines are discussed, including the need to reach agreement on the standards of evidence for clinical effectiveness. Strategies are discussed for increasing the application of behavioral research findings for multicomponent treatment and population-based preventive interventions.