Clinical Practice Guidelines: Methodological Considerations

Development and implementation of clinical practice guidelines suffer from the lack of a systematic, consistent methodology. This lack of rigor is certainly due in part to the absence of a complete, standardized methodology that has unequivocal effects. However, a more important source of slippage is lack of awareness of the conceptual framework that underlies methods for developing guidelines and making them operational. Explaining this conceptual framework can best be done by attempting to address the following frequently posed central problems: What is the operational definition of a guideline? What is the conceptual framework for implementing guidelines? How does one determine guideline effectiveness? Though space does not allow an exhaustive examination of these central problems, the following discussion attempts to emphasize aspects that seem to be particularly vexing.