Clinical Practice Guidelines We Can Trust (2011) / Chapter Skim
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Rather than dictating a one-size-fits-all approach to patient care, CPGs are able to enhance clinician and patient decision making by clearly describing and appraising the scientific evidence and reasoning (the likely benefits and harms) behind clinical recommendations, making them relevant to the individual patient encounter.
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Furthermore, evidence supporting clinical decision making and CPG development relevant to subpopulations, such as patients with comorbidities, the socially and economically disadvantaged, and those with rare conditions, is usually absent. More generally, the quality of CPG development processes and guideline developer adherence to quality standards have remained unsatisfactory and unreliable for decades.
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to "identify the methodological standard for conducting systematic reviews 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 (2) to focus on "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." The IOM formed two committees, the Committee on Standards for Systematic Reviews of Comparative Effectiveness Research and the Committee on Standards for Developing Trustworthy Clinical
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The committee also considered methods for modifying CPGs for patients with multiple conditions; ways to reduce the number of overlapping guidelines and harmonize CPGs on the same topic; strategies to promote and evaluate adoption of development standards and trustworthy CPGs; means to distinguish trustworthy CPGs; and procedures for identifying guideline recommendations potentially appropriate for measuring the quality of healthcare systems or clinicians. CLINICAL PRACTICE GUIDELINES: A NEW DEFINITION The literature assessing the best methods for guideline devel opment has evolved dramatically in the 20 years since the IOM's first report on the subject, Clinical Practice Guidelines: Directions for a New Program, which defined CPGs as "systematically developed statements to assist practitioner and patient decisions about appro priate health care for specific clinical circumstances." The committee saw the need to update this definition, in accordance with the AHRQ contract, and to better reflect current consensus on what constitutes a CPG, including aspects of guideline development that the committee believes are defining characteristics.
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However, even given such constraints, guideline developers may still produce trustworthy CPGs if their development reflects those committee standards detailed below. STANDARDS FOR TRUSTWORTHY CLINICAL PRACTICE GUIDELINES As enumerated below, the committee's proposed standards reflect the latest literature, expert consensus, and public comment, and the committee hopes they represent an important advance in the newest and best practice standards for CPG development.
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4. Clinical Practice Guideline–Systematic Review Intersection 4.1 Clinical practice guideline developers should use sys tematic 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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8.2 Literature should be monitored regularly following CPG publication to identify the emergence of new, potentially relevant evidence and to evaluate the continued validity of the CPG.
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The committee derived several recommendations directly relevant to the ultimate effectiveness of the eight standards in increasing the quality and trustworthiness of CPGs and enhancing healthcare quality and patient outcomes. RECOMMENDATIONS FOR IDENTIFYING AND EVALUATING TRUSTWORTHY CLINICAL PRACTICE GUIDELINES The committee views all eight proposed standards as essential elements in the development of trustworthy guidelines.
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should promote the identification of best practices in CPG development, guided by the committee's proposed standards, and should assist in training individuals in specific technical skills needed in the CPG process, particularly patient and consumer representatives. Furthermore, to encourage the promulgation and adoption of standards, the committee recommends HHS create a mechanism to identify trustworthy guidelines.
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The NGC is a highly useful guideline dissemination tool. AHRQ should continue to operate this service, and expand its capacities to provide syntheses of recommendations by clinical topic and con duct research on best guideline development practices.
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will offer unique opportunities to rapidly move clinical knowledge from the scientific literature to the patient encounter. To achieve this goal, guideline developers should structure CPGs to facilitate ready implementation of electronic clinical decision support by health systems (e.g., clinical practices, payers, delivery systems, hospitals)
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Yet, as medical, biomedical, and health services research advance, translation of scientific evidence increasingly reduces uncertainty in clinical practice. However, requisite to this promise are clinician and patient access to trustworthy clinical practice guidelines informed by highquality evidence and a guideline development process reflective of best practices.
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