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Is Your Clinica..

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Information is being generated and published at a rate never before seen. In a time where clinicians are supposed to be making decisions based on the current best evidence, yet the evidence is greater than 25,000 new randomized controlled trials published per year, how is this possible? Much of this new information is of uncertain value. Many experts believe that clinical practice guidelines (CPGs) developed using scientific rigor can improve clinical decision-making.

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In 2008 an Institute of Medicine (IOM) report Knowing What Works in Healthcare was presented to the U. S. Secretary of Health. As a result, Congress under the auspices of the Medicare Improvement for Patients and Providers Act of 2008 contracted with the IOM and the Agency for Healthcare Research and Quality (AHRQ) to determine “the best methods used in developing clinical practice guidelines in order to ensure that organizations developing such guidelines have information on approaches that are objective, scientifically valid, and consistent.” This report was published in 2011. The committee also developed a new definition of a CPG that correlated more closely with their beliefs. The definition is as follows: Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options. The committee proposed eight standards that should be assessed when evaluating whether a CPG is trustworthy. A shortened and edited version of these standards is listed below.

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Standards for Developing Trustworthy Clinical Practice Guidelines

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1. Establishing transparency

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      a. The processes by which a CPG is developed and funded should be detailed explicitly and publicly accessible.

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2. Management of Conflict of Interest (COI)

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      a. Prior to selection of the guideline development group (GDG), individuals being considered for membership should declare all interests and activities potentially resulting in COI with development group activity, by written disclosure to those convening the GDG.

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      b. Whenever possible GDG members should not have COI.

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      c. In some circumstances, a GDG may not be able to perform its work without members who have COIs.

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      d. The chair or cochair should not have a COI.

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3. Guideline Development Group Composition

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      a. The GDG should be multidisciplinary and balanced comprising a variety of methodological experts and clinicians, and populations expected to be affected by the CPG.

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4. Clinical Practice Guideline-Systematic Review Intersection

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      a. Clinical practice guideline developers should use systematic reviews that meet standards set by the Institute of Medicine’s Committee on Standards for Systematic Reviews of Comparative Effectiveness Research.

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5. Establishing Evidence Foundations for and Rating Strength of Recommendations

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      a. For each recommendation, the following should be provided:

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        i. An explanation of the reasoning underlying the recommendation, including

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          1. A clear description of potential benefits and harms;

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          2. A summary of relevant available evidence, description ...

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