Clinical guidelines: Developing guidelines

BMJ 1999;318:593-596 ( 27 February )

Education and debate

Clinical guidelines

Developing guidelines

This is the second in a series of four articles on issues in the development and use of clinical guidelines

Paul G Shekelle, senior research associate, Health Services Research and Development Service, ^a Steven H Woolf, professor of family medicine, ^b Martin Eccles, professor of clinical effectiveness, ^c Jeremy Grimshaw, professor of public health. ^d

^a West Los Angeles Veterans Affairs Medical Center (111G), 11301 Wilshire Blvd, Los Angeles, CA 90073, USA, ^b Department of Family Practice, Virginia Commonwealth University, Fairfax, Virginia 22033, USA, ^c Centre For Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA, ^d Health Services Research Unit, University of Aberdeen, Aberdeen AB9 2ZD

Correspondence to: Dr Shekelle shekelle@rand.org

The first 150 words of the full text of this article appear below.

The methods of guideline development should ensure that treating patients according to the guidelines will achieve the outcomesthat are desired. This article presents a combination of the literatureabout guideline development and the results of our combined experiencein guideline development in North America and Britain. It considersthe five steps in the initial development of an evidence basedguideline. The dissemination, implementation, and evaluation ofpractice guidelines will be discussed in the final article inthis series.¹

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Identifying and refining the subject area of a guideline

Prioritising topics
Guidelines can be developed for a wide rangeof subjects. Clinical areas can be concerned with conditions (abnormaluterine bleeding, coronary artery disease) or procedures (hysterectomy,coronary artery bypass surgery). Given the large number of potentialareas, some priority setting is needed to select an area for guidelinedevelopment. Potential areas can emerge from an assessment ofthe major causes of morbidity and mortality for a given population,uncertainty . . . [Full text of this article]

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