Practice Guidelines

Pursuant to a congressional request, GAO examined medical specialty societies' methods for developing effective medical practice guidelines.

GAO found that medical specialty societies: (1) lacked uniformity in developing practice guidelines; (2) varied in the types of guidelines they produced, although guidelines usually included recommendations for a specific action for a given clinical situation; (3) usually formulated guidelines to improve quality of care or to defend against a variety of forces outside their specialties; (4) generally used committees and oversight bodies to develop and review guidelines; (5) usually evolved their own multiple-step processes for guideline development by using literature review and clinical consensus among committee members and incorporating outcomes management information; (6) disseminated guidelines to all society members at low cost through existing vehicles; (7) considered various provisions for updating guidelines to keep them relevant; (8) spent considerable time and money to shape and launch guideline development programs; and (9) had varied opinions on guideline recommendations, use of legal disclaimers, public disclosure, and mechanisms to achieve compliance. GAO also found that it was unable to make any recommendations on guideline development because of the: (1) variability in guideline development in the past and in the opinions about how it should proceed in the future; and (2) absence of evaluative studies on guideline development and guideline impacts.