Education And Debate

Fortnightly Review: Development of review criteria: linking guidelines and assessment of quality

BMJ 1995; 311 doi: (Published 05 August 1995) Cite this as: BMJ 1995;311:370
  1. Richard Baker, directora,
  2. Robin C Fraser, directorb
  1. aEli Lilly National Clinical Audit Centre, Department of General Practice, University of Leicester, Leicester LE5 4PW,
  2. bDepartment of General Practice, University of Leicester, Leicester
  1. Correspondence to: Dr Baker.
  • Accepted 5 August 1995

Review criteria are designed to enable clinicians and others to assess care. However, there is no established method for developing criteria, and they are often confused with guidelines. Criteria should comprise measurable activities that are appropriate for the setting in which they are to be used. They should also be based on research evidence and prioritised according to the strength of that evidence and effect on outcome. Good criteria can be used to aid implementation of guidelines by providing a standard against which to monitor performance and enabling clinical audit.

In the continuing debate about the most effective methods for assessing high quality care reference is often made to “guidelines” and “review criteria.” Although the purpose of guidelines is to assist in making clinical decisions and criteria are used in the assessment of care1 (box 1), these crucial distinctions are not always clearly made, leading to confusion about their development and application in clinical practice. Furthermore, much less attention has been given to methods for developing and using review criteria compared with guidelines. In improving care, sound measures for the assessment of quality are as necessary as “systematically developed statements to assist practitioner and patient decisions.”1 The aims of this paper are, firstly, to make explicit the desirable attributes of criteria and, secondly, to propose a framework for linking them with the process of development of guidelines.

View this table:
Box 1

Definitions of guidelines, criteria, and protocols for clinical practice

The respective roles of guidelines and criteria can be clarified by the following example. The guidelines of the British Hypertension Society state that “great emphasis should be placed on encouraging patients to stop smoking as the coexistence of smoking as an additional risk factor in hypertensive patients confers a much increased risk of subsequent cardiovascular events.”2 To convert this guideline into …

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