Practice policies: where do they come from?

RECENT changes in the methods used to create practice policies have the potential to affect the quality and cost of medical care more profoundly than all the new treatments of the past or next decade. This potential comes from the fact that changes in methods for designing policies can be expected to change the content of policies, which in turn will guide hundreds of thousands of decisions about all interventions (preventive and diagnostic, as well as treatment), for decades to come. The changes currently under way in methods for designing practice policies represent a change in the intellectual basis of medicine. The purpose of a practice policy is to anticipate and simplify decisions that would otherwise have to be made on a one-by-one basis by individual physicians and their patients.1Thus, the tasks involved in the design of a policy correspond to the two steps used by individuals for