Agency for Health Care Policy and Research Clinical Practice Guidelines: government intervention or cost-effective help?

Abstract

See also page 1117. IN THIS ISSUE, The AnnaLs begins a series of articles cri­ tiquing the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines. Perfetto and Mor­ ris· provide a history of the development of the guidelines and the process that each guideline undergoes before being published. As these authors describe, the agency is under scrutiny by healthcare forces seeking to influence its work and congressional forces trying to determine whether the agency will continue to exist. Currently, few data exist de­ scribing the application of these guidelines to real-world healthcare systems and the guidelines' resulting impact on the quality and cost of care. The development of any guideline in medicine is often controversial. The guidelines established under the aus­ pices of the federal government can only help spark con­ troversy. Arguments have ranged from the cry of cook­ book medicine to hailing the guidelines as unbiased, cost­ effective help.2-4 Regardless of your position on these issues, the guidelines are likely to have enormous impact on the current managed care and group practice environ­ ment. Local discussion of the guidelines will follow the national debate as they are modified to allow sanction by group practices. Therefore, it is essential that these guide­ lines be thoroughly discussed and analyzed. To this end, clinicians experienced in these areas will critique the guidelines to begin a dialogue on how they should be used. Because several of these guidelines are already dated, rele­ vant new data published since their release will be incorpo­ rated in the articles. Critics of the AHCPR guidelines argue that a govern­ ment program is not necessary to develop cost-effective guidelines. Groups such as the American College of Chest Physicians, the American Academy of Pediatrics, and the American Society of Health-System Pharmacists have de­ veloped position statements, protocols, and guidelines on