Abstract
Providing quality cost-effective health care to all Americans is one of our society's highest priorities. In an era of uncertainty, the only certainty is that significant changes in the structure and provision of health care will occur during the next decade. One key component of change will be the increased prominence and use of measures to help guide physicians in the care of patients in all of medicine. 1 Indeed, such measures have been proposed as playing a useful role in reducing the magnitude of unexplained geographic variation in the provision of services and in reducing inappropriate care, thereby reducing the cost of health care while improving the quality of care. 2 To this end, the federal government in 1989 created the Agency for Health Care Policy and Research (AHCPR), charged with developing and disseminating practice guidelines to supplement ongoing efforts of physician societies, hospitals, insurers, and independent research centers.
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