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A consensus-based approach to practice parameters.

A practice parameter is any guide to the clinical management of a patient. The specificity of these will vary, as will the purpose for which they are written. The "who," "why," and "how" issues are new and legitimate concerns for the medical profession. Medicolegal issues, cost of care, and quality of care are but three of the "whys" that may be addressed by guidelines. Guidelines may differ in subtle but important ways depending on their purpose and who has been selected to write them. Great emphasis has now been placed on the process of writing guidelines. However, physicians have concerns with the basic concept, including the possible emergence of "cookbook" medicine, the effect of patient variability, and the need to keep guidelines current. Guidelines must be valid and credible to be useful. The consensus-based approach, used by ACOG to achieve these ends, includes a four-tiered system of peer review and recognizes the importance of flexibility in any guidelines for clinical practice.