Translation of appropriateness criteria into practice guidelines: application of decision table techniques to the RAND criteria for coronary artery bypass graft.

The process of creating clinical practice guidelines from collected evidence has not been well defined. We have developed a technique for translation of a comprehensive set of appropriateness criteria into a usable set of practice guidelines. The criteria are derived from a formal consensus process conducted by RAND and relate to indications for coronary artery bypass graft in acute myocardial infarction. The clinical indications defined by the expert panel are entered as conditions in a decision table. For each combination of relevant clinical findings, the recommended action is defined from the median ranking of the Rand panel. The fully constructed table is next compacted by conventional decision table techniques and sorted to facilitate parsing the knowledge. Ultimately, 8 narrative statements are derived from 51 rules. Augmented decision tables permit display of detailed data in the summary table and its access on an as-needed basis.