Clinical Practice Guidelines We Can Trust (2011) / Chapter Skim
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1 Introduction
1 Introduction
Pages 15-28
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From page 15... ...
The new definition reads: Clinical Practice 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. Following the definition, the committee identifies essential attributes for a CPG to be considered trustworthy.
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From page 16... ...
The agency contracted with the IOM for expert advice on launching this function, and in 1990, the IOM's Committee to Advise the Public Health Service on Clinical Practice Guidelines issued its report, Clinical Practice Guidelines: Directions for a New Program. In 1990, the IOM defined CPGs as "systematically developed statements to assist practitioner and patient decisions about appro priate health care for specific clinical circumstances" (IOM, 1990, p.
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This resulted in the IOM report, Setting Priorities for Clinical Practice Guidelines (IOM,
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Clinical Applicability: Practice guidelines should be as inclusive of appro priately defined patient populations as scientific and clinical evidence and expert judgment permit, and they should explicitly state the populations to which statements apply. Clinical Flexibility: Practice guidelines should identify the specifically known or generally expected exceptions to their recommendations.
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From page 19... ...
Although many of that report's recommendations became moot when AHCPR discontinued its guideline development function, one conclusion of the report remains relevant: the agency should serve as a clearinghouse and disseminate guidelines developed by others. In 2008, the current status of clinical practice guidelines was discussed in the IOM report, Knowing What Works in Health Care: A Roadmap for the Nation (IOM, 2008)
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Many current clinical practice guidelines suffer from limitations in the scientific evidence base and shortcomings in the guide line development process (IOM, 2008; Shaneyfelt and Centor, 2009)
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Specifically, Congress requested the IOM to undertake two studies: one "to identify the methodological standards for conducting systematic review of clinical effectiveness research on health and health care in order to ensure that organizations conducting such reviews have information on methods that are objective, scientifically valid, and consistent" and the other to focus on "the best methods used in developing clinical practice guidelines in order to ensure that organizations 2 Medicare Improvements for Patients and Providers Act, Public Law 110-275, 110th Cong.
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IOM Committee Charge Given the MIPPA legislative charge to the IOM mentioned previously, the IOM formed the Committee on Standards for Developing Trustworthy Clinical Practice Guidelines to concentrate on processes for the development of unbiased, scientifically valid, and trustworthy clinical practice guidelines. The committee examined existing standards for guideline development, assessing which might be suitable for adoption or adaptation in the United States.
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. For SRs to support development of a CPG, the SRs need to address clinical questions critical to formulation of a recommendation about a particular clinical practice in a certain circumstance.
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Public Forum, January 11, 2010 Sixteen individuals and organizations responded to the committee's broadly disseminated invitation to present public testimony at its second meeting. Respondents were asked to offer advice regarding the key issues the committee should address in deriving standards for clinical practice guideline development.
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Sittig These papers contributed to committee discussion and the evidentiary underpinnings of its report, although the perspectives and any implicit recommendations within each are solely those of the authors. PURPOSE AND UPDATED DEFINITION OF CLINICAL PRACTICE GUIDELINES Clinical Practice Guidelines are statements that include recommendations intended to optimize patient care.
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From page 26... ...
The new definition provides clarification of the term "CPG," which in the past was commonly used to describe clinical guidance derived from widely different development processes and statements taking various forms, including consensus statements, practice bul letins, expert advice, quality measures, and evidence-based recom mendations. This study emphasizes characteristics that distinguish among methodologically rigorous, transparent, evidence-based guidelines (CPGs)
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Chapters 4 and 5 discuss current best practices in the guideline development process and emphasize critical elements in the creation of trustworthy CPGs, including methods for systematic appraisal of the guideline development process. These chapters include pro posed standards for guideline development.
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Paper presented at IOM Com mittee on Standards for Developing Trustworthy Clinical Practice Guidelines meeting, November 11, 2010, Washington, DC. Chauhan, S
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