The political anatomy of a guideline: a collaborative effort to develop the AHCPR-sponsored practice guideline on otitis media with effusion.
BACKGROUND
In July 1991 the Agency for Health Care Policy and Research (AHCPR) invited private organizations to develop a practice guideline on otitis media. The American Academy of Pediatrics (AAP) collaborated with the American Academy of Family Physicians, the American Academy of Otolaryngology-Head and Neck Surgery, and the Department of Pediatric Otolaryngology at the University of Pittsburgh in preparing a proposal. The AAP--the prime contractor--and the consortium were awarded the contract in October 1991. The 19-member panel assessed evidence and achieved consensus on most recommendations and maintained positive relationships that helped them function as a group.


CONCLUSIONS
The practice guideline project has influenced the AAP's own evidence-based practice parameter methodology. Many lessons were learned. For example, since any project is only as strong as its weakest link, it was important to build the proposal on organizational strengths--including access to a combined 244,000 members and other resources. The weak links were the large number of persons involved in the project, their varying time commitments, and the wide geographic distribution of those involved. Also, neither AHCPR nor any of the organizations involved in the consortium had previous government contract experience in developing practice guidelines, so that much of the process became "on-the-job training".
Research is needed to determine the extent to which the otitis media guideline is being used. The three academies are conducting a follow-up practice pattern variation study of pediatricians, family physicians, and otolaryngologists, which may provide data on behavior change with regard to managing the condition.
Sebring
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Division of Quality Care, American Academy of Pediatrics, Elk Grove Village, Illinois 60009-0927, USA. rsebring@aap.org.
Herrerias
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D005194:Family Practice; D006801:Humans; D007373:Interinstitutional Relations; D010034:Otitis Media with Effusion / Q000628:therapy*; D010036:Otolaryngology; D010372:Pediatrics; D011057:Politics; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care; D012955:Societies, Medical; D014481:United States; D016270:United States Agency for Healthcare Research and Quality