In response to your request that we examine methods for the development of guidelines, we reviewed the experience of medical specialty societies that have developed them. We contacted 35 societies that were identified by the American Medical Association or the Council of Medical Specialty Societies as possessing or developing guidelines and inquired of each whether their guidelines met the following definition:

how much effort was required to produce guidelines.

The society representatives' responses to these questions are provided

in appendix II. Even a cursory review of those responses is sufficient to establish that there is no uniformity when it comes to developing practice guidelines. Medical societies vary in

the reasons why they develop guidelines (to improve quality, to guard against intrusions by others);

the types of guidelines they produce (ranging from a 3-page quality assessment tool to a book with recommendations on whether, when, and how to treat a host of medical conditions);

the focus of their guidelines (procedures, diagnoses);

⚫ the persons they involve in development (most use physician members, but some include nonmembers or seek the advice of nonphysicians); and

In the course of our interviews, we also asked society representatives for their views on what characteristics guidelines should have, how guideline development should proceed, and how to maximize compliance with the guidelines and evaluate their impact. Appendix III presents the responses of the representatives on these issues, which are best characterized as varied.