NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.

Support for this project was provided by the John A. Hartford Foundation of New York City and by the Agency for Policy and Research, U.S. Department of Health and Human Services, under Contract No. 282-90-0018. Additional funds were provided by the Blue Cross and Blue Shield Association, CIGNA Foundation, the Prudential Foundation, and the American College of Cardiology. The views presented are those of the Institute of Medicine Committee on Clinical Practice Guidelines and are not necessarily those of the funding organizations.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.S.). Committee on Clinical Practice Guidelines.

Guidelines for clinical practice : from development to use / Committee on Clinical Practice Guidelines. Division of Health Care Services, Institute of Medicine ; Marilyn J. Field and Kathleen N. Lohr, eds.

p. cm.

Includes bibliographical references and index.

1. Medical care—Standards—United States. I. Field, Marilyn Jane. II. Lohr, Kathleen N., 1941- . III. Title.

[DNLM: 1. Clinical Medicine—standards—United States. 2. Delivery of Health Care—standards—United States. 3. Quality of Health Care—standards—United States. W 84 AAI I485g]

RA399.A3I56 1992

362.1'021873—dc20

DNLM/DLC

for Library of Congress 92-8613

CIP

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted a logotype by the Institute of Medicine is based on a relief carving from ancient Greece. now held by the Staatlichemuseen in Berlin.