Introduction: The growing interest and increasing acceptance of practice guidelines as a tool to facilitate the uptake of research findings into clinical practice and to improve quality of care is accompanied by a recognition that much greater attention should be paid to how they are developed, disseminated and, especially, implemented. While this is happening, the number of those producing guidelines is increasing dramatically, without much attention to the quality of what goes into the "market" of practice guidelines. Following some reports documenting large and unacceptable variations in the quality of existing guidelines and considering the perceived needs of valid and reliable tools for the diffusion of evidence based health care, a pilot project was launched by the Italian Cochrane Centre in 1995 involving 25 local Health Units.

Objective: The three main objectives of the projects were as follows: a) to improve the critical appraisal skills of purchasers and providers; b) to develop the experience and skill necessary to identify all those factors that may facilitate or prevent, locally the guidelines' implementation; c) to develop and make available to participants a database of critically appraised practice guidelines produced internationally. The aim of the database was to facilitate access of interested professionals to existing guidelines and to provide them with selected information on the quality of the methodology used for their production. The database provides references, keywords and abstract of more than 1.000 guidelines. The paper version of the guidelines is stored at the Coordinating Centre and is available to project participants by mail.

Methods/Results/Discussion: The database also contains a simple "critical appraisal form" of the methodologic quality of the guidelines. Specifically the following quality items have been systematically assessed: a) description of the method used to identify and collect the evidence on which recommendations are based; b) description of the individuals involved in developing the guideline (multidisciplinary vs monodisciplinary panel); c) whether or not a formal assessment of the strength of evidence is attached to specific recommendations. The paper discusses the results of the quality assessment of a group of 338 practice guidelines produced by Scientific Societies internationally, identified through Medline, and published between January 1994 and 24 July 1997 in international medical journals.