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2 Background and Key Stakeholders in Guidelines Development and Use
Pages 29-52

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From page 29...
... BACKGROUND "Clinical practice guidelines are now ubiquitous," observed Weisz and colleagues in 2007 (p.
From page 30...
... This chapter provides a brief review of modern applications of scientific evidence in the development of clinical care and evolution of CPGs. It then offers an overview of many participants in current CPG development and use, providing selected examples.
From page 31...
... . Health sci ences literature growth was concentrated in clinical research, with an increase in the percentage of studies with human subjects, and Medical Subject Headings (MeSH)
From page 32...
... Alvan Feinstein and David Sackett were the first to introduce clinical epidemiology as a distinct clinical discipline at Yale University (1968) and McMaster University (1970)
From page 33...
... The EBM paradigm assigns reduced weight to authority of experts, instead valuing physician understanding of underlying rigorous, high quality scientific evidence in patient care provision (Evidence-Based
From page 34...
... . Evolution of Clinical Practice Guideline Development Clinical practice guidelines (CPGs)
From page 35...
... . The involvement of specialty societies in practice guidelines development increased dramatically throughout the 1980s and 1990s.
From page 36...
... The next two sections discuss examples from stakeholder classes: government agencies, clinical specialty societies, disease-specific societies, and other private and international organizations that develop guide lines and are key players. The examples illustrate the variety of organizations involved with CPGs, and are not intended to be allinclusive.
From page 37...
... The previously mentioned Consensus Development Program of NIH issues three to five major evidence-based consensus statements annually, extending from highly structured conferences on controversial clinical topics of use to the broad medical community and general public (NIH, 2009)
From page 38...
... . Clinical Specialty Societies Many medical societies and organizations of other healthcare professionals have taken responsibility for CPG development in responding to members' requests for guidance on best treatment practices and as an opportunity to provide continuing education.
From page 39...
... For example, the Alzheimer's Association has produced three guidelines currently listed in NGC, including one entitled Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes: Phase 3 End-of-Life Care (NGC, 2010a)
From page 40...
... Panel partici pants included members of the American Academy of Orthopedic Surgeons, American Board of Internal Medicine, American College of Emergency Physicians, American Geriatrics Society, American Medical Association, American Occupational Therapy Association, American Physical Therapy Association, American Society of Consultant Pharmacists, British Geriatrics Society, John A Hartford Foundation Institute for Geriatric Nursing at New York University, and National Association for Home Care and Hospice (AGS, 2010)
From page 41...
... McKesson, a large corporation providing services to healthcare providers and insurers, produces clinical practice guidelines in its Interqual Division. These are the two main purveyors of commercial guidelines.
From page 42...
... NICE staff offer consulting services internationally to assist in adoption of NICE standards and CPG development methodologies, particularly those related to integra tion of scientific evidence and social values in health care policy and clinical decision making. NICE also issues a suite of products for each review and guideline it produces, including shorter NICE guidelines, full guidelines with systematic reviews, consumer summaries, and implementation assistance (NHS, 2010)
From page 43...
... . KDIGO, an international guideline development organization, was established in 2003 to promote the "coordination, collaboration and integration of initiatives to develop and implement clinical practice guidelines" (Eknoyan et al., 2004, p.
From page 44...
... 3. Corroborating documentation can be produced and verified to prove that a systematic literature search and review of existing scientific evidence published in peer-reviewed journals were performed during the guideline development.
From page 45...
... Under the Patient Protection and Affordable Care Act, Medicare (and commercial insurers) will be required to include coverage of preventive services that receive a highly rated recommendation from a CPG of the USPSTF.6 • Medicare's quality improvement program, contracted through Quality Improvement Organizations in each state, 5 Evidence-based in this case does not denote that a systematic review of the evi dence was conducted.
From page 46...
... , a Scottish-based, not-for-profit, international association of 50 individuals and 91 organizations representing 39 countries, was founded in 2002 to promote development and use of CPGs, in part by collecting published CPGs (Guidelines International Network, 2010a)
From page 47...
... . Funders of CPGs Funders of CPG development play a critical role in the process; however, the committee found no systematic sources of information regarding CPG funders or their levels of financial support.
From page 48...
... 2008. Evidence-based Practice Centers: Synthesizing scientific evidence to improve quality and effectiveness in health care.
From page 49...
... Presented at the IOM Committee on Standards for Developing Trustworthy Clinical Practice Guidelines meeting, January 11, 2010, Washington, DC. The Cochrane Collaboration.
From page 50...
... Paper presented at the IOM Committee on Standards for Developing Trustworthy Clinical Practice Guidelines meeting, January 11, 2010, Washington, DC. Jacques, L
From page 51...
... Paper presented at the IOM Committee on Standards for Developing Trustworthy Clinical Practice Guidelines meeting, January 11, 2010, Washington, DC.
From page 52...
... Paper presented at the IOM Committee on Standards for Developing Trustworthy Clinical Practice Guidelines meeting, January 11, 2010, Washington, DC. Weisz, G., A


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