A Brief History of Clinical Practice Guidelines

It is believed that CPGs arose in the context of an increased focus on public health in the early 1900’s in the United States where a series of serious disease outbreaks such as yellow fever, typhoid, and tuberculosis, led health officials to raise public health standards. Programs were created to implement standardized practices for prevention, diagnosis, and treatment of these diseases.

The first two guidelines were published in 1931 – one for organizing cancer services in hospitals and another on fracture care. In 1938, practice guidelines for children’s immunization were produced. This was followed by a period after World War II characterized by a tremendous increase in research funded by the government, which in turn led to an increase in the production of practice guidelines on various emerging healthcare topics (e.g., cancer, coronary disease, sports medicine, anticoagulant therapy, etc.). Twenty (20) guidelines were published between 1945 and 1959. Another 35 guidelines were published between 1960 and 1974. The vast majority of guidelines were American, with a handful of British contributions.

From the mid-1970s on, the production of guidelines intensified in many different countries. In 1989, the federal Agency for Healthcare Research and Quality was established in the U.S. with a mandate to produce practice guidelines. This was done in response to various concerns such as cost containment, variations in medical procedures and their effectiveness, and a need to establish consensus on appropriate practice standards. By 1991, guidelines were ubiquitous enough for the National Library of Medicine’s PubMed to add “Guidelines” to its list of publication types.