The federal government is getting out of the business of drafting clinical practice guidelines.
After publishing 18 guidelines since 1992, the Agency for Health Care Policy and Research has decided to become a "science partner" for private- and public-sector organizations and providers trying to establish their own guidelines for providing effective, high-quality care.
The AHCPR, part of HHS, is spinning off its guideline development effort into three research programs: one that will focus on collecting and synthesizing published data for organizations that want to draft their own guidelines; one that will monitor development and use of guidelines; and a database of existing clinical practice guidelines. Before it abandons its former role, the AHCPR will publish two more guidelines for which research already has begun.
Private-sector organizations value the AHCPR's data collection and synthesis more than the actual practice guidelines, partly because they often cannot afford to conduct such research, agency officials said.
The change in the guideline program, which was triggered by congressional scrutiny of agency costs, is being lauded by a number of provider groups.
Providers had criticized the AHCPR's guideline development process, saying it was cumbersome and did not result in guidelines that hospitals, managed-care plans and clinics adopted without modification.
Health plans, for instance, often used the data included in AHCPR guidelines as a "seed" for drafting their own guidelines but did not adopt the agency's standards, said Liza Greenberg, director of medical affairs at the Association of American Health Plans.
The agency's guideline-related products now will be "a concise analysis and statement of what the conclusions of science are on specific procedures and medical interventions," said Administrator Clifton Gaus.
"There will be more scholarly research
*.*.*.*targeted to the developer of guidelines, not the practicing clinician," Gaus said.
The agency's move away from guideline development also may be inspired by self-preservation. Experts said some of the guidelines have angered politically powerful medical specialties, which in turn have sought assistance from congressional allies in seeking to gut the agency.
Although the AHCPR will conduct its research at the request of private- and public-sector organizations, Gaus said there are no plans to charge a user fee for those services. Because cost is the reason providers can't conduct such research now, he said, there would be no way for the agency to charge a fee providers could afford.
The AHCPR last year became a target of congressional budget-cutters, who derided the guidelines-which have cost between $500,000 and $1 million apiece to produce-as costly examples of government waste. One member of Congress called the AHCPR the "Agency for High Cost Publications and Research."
Partly as a result of those characterizations, Congress cut the agency's fiscal 1996 budget by 22% to $125 million. The AHCPR is seeking $143.8 million for fiscal 1997, which begins Oct. 1.