The full content of Annals is available to subscribers

Subscribe/Learn More  >
Ideas and Opinions |

Medical Practice Guidelines: Current Activities and Future Directions

Anne-Marie Audet, MD; Sheldon Greenfield, MD; and Marilyn Field, PhD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Sheldon Greenfield, MD, The Institute for the Improvement of Medical Care and Health, New England Medical Center Hospitals, 750 Washington Street, Box 345, Boston, MA 02111.

Current Author Addresses: Drs. Audet and Greenfield: The Institute for the Improvement of Medical Care and Health, New England Medical Center Hospitals, 750 Washington Street, Box 345, Boston, MA 02111.

Dr. Field: The Institute of Medicine, National Academy of Sciences, 2101 Constitution Avenue, NW, Washington, DC 20418.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;113(9):709-714. doi:10.7326/0003-4819-113-9-709
Text Size: A A A

Objective: To examine the state of the art in the field of medical practice guidelines, to identify limitations, and to suggest future directions.

Design: Informal descriptive survey using a questionnaire administered by telephone, supplemented by comments, by opinions, and by examples solicited from the participating organizations.

Participants: Eight prominent organizations representing prototype approaches to guideline development; these organizations included three medical societies, two health care organizations, two insurers, and one private health benefits management company.

Results: Improving the quality of medical care was a stated goal of all eight surveyed organizations. However, their objectives have not been stated in operational terms, reflecting the lesser emphasis placed on methods and means for both implementing guidelines and evaluating their impact on health practices and outcomes. In contrast, several systematic methods for developing guidelines exist. They differ in the stress placed on formal literature reviews, reliance on local as opposed to national experts, and formal methods of group judgment, but no evidence exists on which approaches produce sounder and more usable guidelines.

Conclusions: Guidelines are being vigorously promoted as a means to improve the effectiveness of the health care system. Current initiatives show both strengths and weaknesses. In particular, the attention now paid to the development of guidelines needs to be matched by attention to implementation strategies and to the scientific evaluation of their effectiveness in real clinical settings. Also, more agreement is needed on acceptable methods for developing guidelines, assessing their content, and evaluating their impact on professional behavior, patient outcomes, and health care costs. Fortunately, several initiatives to bring greater order and quality to this field are under way.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.