LARRY CULPEPPER AND JANE SISK
Guidelines: A Case Study of
Otitis Media with Effusion
The development of clinical-practice guidelines has received high priority from public and private policy makers seeking to improve the quality of care and to contain costs. Federal guideline activities have centered on the Agency for Health Care Policy and Research (AHCPR), which was mandated in 1989 legislation to develop guidelines for common conditions and procedures. Since then, AHCPR has published more than a dozen guidelines.
The eventual purpose of clinical practice guidelines is to make practice consistent with the best evidence available. The credibility of the recommendations and the process used to develop them are likely to influence their acceptance by clinicians, patients, and the public whose behavior the guidelines are intended to influence. Guidelines formulated by AHCPR and other government agencies may be handicapped, however. A recent survey of internists suggested that physicians rank most highly guidelines developed by physician societies, followed by those developed by the National Institutes of Health, the U.S. Preventive Services Task Force, and, last, AHCPR. 1 A consortium of physician societies funded by AHCPR, as exemplified by the one which developed the otitis media with effusion guideline, thus promises to enhance the credibility and acceptance of the resulting guidelines.
The process by which guidelines are developed also might influence their adoption and use. 2 This process affects the validity of the recommendations that result and their credibility to clinicians and the public. Guideline development includes the following major activities: selection of guideline topic, task allocation of panel responsibilities, panel composition, development and evaluation of evidence, and development of conclusions and recommendations. Development of medical review and quality assessment measures and research