Specific issues related to developing, disseminating, and implementing pediatric practice guidelines for physicians, patients, families, and other stakeholders.
OBJECTIVE
To describe ways in which medical information should be developed and disseminated, focusing on pediatric practice guidelines as an example of one type of information.


RESULTS
The methodology of guideline development is well known and has been previously reviewed. Guideline development poses problems for many medical specialties, but particularly for pediatrics, because (1) few diseases are prevalent, (2) only limited randomized controlled trials have been conducted with respect to specific diagnostic and therapeutic options, and (3) clinicians often are dealing with patient surrogates--parents--rather than with the actual patient. Patient and family involvement in guideline development and dissemination has been limited and may affect the likelihood that guidelines will be adopted and subsequently improve child health outcomes. The science of dissemination, including guidelines and other information, is poorly developed. Little is known about the most effective ways to ensure that guidelines reach clinicians and are adopted. Finally, the effect of guidelines on child health outcomes is itself uncertain.


CONCLUSIONS
(1) Research efforts should focus on guideline dissemination and adoption. (2) The effect of guideline implementation on health outcomes needs to be better understood. (3) Parents should be more involved in guideline dissemination and adoption.
Division of General Pediatrics, Boston University School of Medicine, MA 02118, USA.
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D000208:Acute Disease; D002648:Child; D002908:Chronic Disease; D004502:Education, Medical, Continuing; D005544:Forecasting; D006302:Health Services Research; D006801:Humans; D007255:Information Services / Q000458:organization & administration*; D010290:Parents / Q000193:education; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards; D012107:Research Design; D014481:United States