Through the Omnibus Budget Reconciliation Act of 1989 the Agency for Health Care Policy and Research (AHCPR) was established as the successor to the National Center for Health Services Research and Health Care Technology Assessment (NCHSR). Under the auspices of the Office of the Forum for Quality and Effectiveness in Health Care, AHCPR is responsible for developing and updating guidelines to be used in the management of clinical conditions. This is being accomplished through AHCPR's Medical Treatment Effectiveness Program (MEDTEP). MEDTEP's purpose is to improve the effectiveness and appropriateness of health care services by determining the effects of health care practices, including nursing practices on patient outcomes. MEDTEP is focusing on four sets of activities: guideline development, dissemination of research findings, data base development, and effectiveness and outcomes research.