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Meeting Standards Important in Developing Guideline

Treatment guidelines are acknowledged to be important to improved patient outcomes, so much so that a bill before Congress would require physicians to follow guidelines. However, developing evidence-based guidelines is more complex than writing down preferred treatments.

To improve treatment guidelines, the Institute of Medicine (IOM) has developed its own guidelines, which were reviewed Sunday during “Understanding Clinical Practice Guidelines.”

“Guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options,” according to the IOM’s Clinical Practice Guidelines We Can Trust.

The IOM’s recommendations were reviewed Sunday by Richard M. Rosenfeld, MD, MPH, AAO-HNSF senior consultant for Quality and Clinical Practice Guidelines and clinical practice guidelines methodologist, and Stephanie L. Jones, AAO-HNSF’s guidelines staff coordinator.

The IOM publication lists seven standards, the first of which is “Establishing Transparency.” This means the processes by which a clinical practice guideline is developed and funded should be detailed and publicly accessible.

The second standard is “Conflict of Interest.” This requires all members of a guideline development group to declare all their interests, with only a minority of group members having an interest.

The third standard is “Guideline Development Group (GDG) Composition.” The GDG should be multidisciplinary and balanced, comprising a variety of methodological experts and clinicians, and populations expected to be affected by the guideline, including patients and the public.

Standard 4 is “Systematic Reviews.” The GDG and a systematic review team should interact regarding the scope, approach, and output of processes.

Standard 5 is “Evidence Foundations.” This means each of a guideline’s recommendations should describe: its benefits and harms; the quality, quantity, and consistency of the evidence; the role of values, opinion, theory, and clinical experience in deriving the recommendations; and ratings of confidence and strength of recommendations.

Standard 6 is “Articulation of Recommendations.” The recommendations should be articulated in a standardized form.

Standard 7 is “External Review.” External reviewers should comprise a full spectrum of relevant stakeholders, including scientific and clinical experts, organizations, agencies, patients, and representatives of the public.

Dr. Rosenfeld concluded by saying that guidelines are not reimbursement policies, performance measures, measures of certification or licensing, or for provider selection or public reporting.