Restructuring of AHCPR's Clinical Practice Guideline Program

Statement Date: May 2, 1996

In April 30 testimony before the House Labor-HHS-Education Appropriations Subcommittee, AHCPR Administrator Clifton R. Gaus, Sc.D., announced a major restructuring of the Agency's clinical practice guideline program to meet the changing needs of the health care system.

"The world of medical care in 1996 is far different from the one that existed in 1989 when AHCPR was created," Dr. Gaus told the Subcommittee, noting that AHCPR staff has consulted extensively with public- and private-sector guideline users. "Their message is clear: they are seeking the scientific foundation from which they can develop their own high-quality, evidence-based guidelines."

In response AHCPR has decided not to develop clinical practice guidelines in Fiscal Year 1997. Instead the Agency will serve as a "science partner" with private- and public-sector organizations—provider societies, health plans, purchasing groups, states, and others—by producing the scientific foundation for them to use in their efforts to improve clinical practice.

Restructuring the guideline program in this way will allow AHCPR to focus its available resources on its well-recognized strengths—the syntheses and meta-analyses underlying the 18 guidelines that AHCPR has released. This new focus will enable AHCPR to address a broader number of conditions and health problems for the same total expenditure.

This change will help decrease duplication, increase coordination and uniformity in the strong scientific underpinning of guidelines, and continue to increase the science base supporting improvements in clinical practice.

AHCPR's New Program

AHCPR's existing guideline development funds would be redirected to support a three-pronged strategy:

• Centers for Evidence-based Practice. These AHCPR-sponsored Centers would respond to the growing demand for literature reviews, evidence tables, decision analyses, meta-analyses, and other products on topics of national interest. Public and private sector organizations—provider societies, health plans, purchasing groups, states, and others—would then use this evidence base to develop and implement their own clinical practice guidelines and other quality improvement measures and activities.
• National Guideline Database. AHCPR would work with national organizations to develop a public-private sector consortium that would support a national online database of clinical practice guidelines. This would allow all clinicians, provider groups, plans, and health systems to obtain information about the major published guidelines. The database could include access information, summaries of the guidelines, full text when available, and annotations comparing the processes and recommendations of multiple guidelines on the same topic.
• Research and Evaluation. AHCPR would continue its program of research and evaluation activities on the development and use of guidelines and other tools to improve clinical care. Research topics would range from guideline development methodology to implementation strategies.

For additional information, contact AHCPR Public Affairs: Karen Migdail, (301) 427-1855 or Salina Prasad, (301) 427-1864.