Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes.

Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review--guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating.

Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON STANDARDS FOR DEVELOPING TRUSTWORTHY CLINICAL PRACTICE GUIDELINES
• Reviewers
• Foreword
• Preface
• Acknowledgments
• Summary
• 1. Introduction
  • BUILDING ON PREVIOUS IOM STUDIES
  • CURRENT STATE OF CLINICAL PRACTICE GUIDELINES
  • STUDY SCOPE
  • PURPOSE AND UPDATED DEFINITION OF CLINICAL PRACTICE GUIDELINES
  • ORGANIZATION OF REPORT
  • REFERENCES
• 2. Background and Key Stakeholders in Guidelines Development and Use
  • BACKGROUND
  • CURRENT MAJOR STAKEHOLDERS IN GUIDELINES DEVELOPMENT AND USE
  • REFERENCES
• 3. Trustworthy Clinical Practice Guidelines: Challenges and Potential
  • INTRODUCTION
  • DEVELOPMENT OF EVIDENCE-BASED CPGs
  • EMPIRICAL ASSESSMENT OF GUIDELINE DEVELOPMENT METHODOLOGY
  • STANDARDIZING GUIDELINE DEVELOPMENT QUALITY APPRAISAL
  • REFERENCES
• 4. Current Best Practices and Proposed Standards for Development of Trustworthy CPGs: Part 1, Getting Started
  • INTRODUCTION
  • ESTABLISHING TRANSPARENCY
  • MANAGEMENT OF CONFLICT OF INTEREST
  • GUIDELINE DEVELOPMENT GROUP COMPOSITION AND GROUP PROCESS
  • CLINICAL PRACTICE GUIDELINE—SYSTEMATIC REVIEW INTERSECTION
  • DETERMINING GUIDELINE SCOPE AND REQUISITE CHAIN OF LOGIC
  • REFERENCES
• 5. Current Best Practices and Standards for Development of Trustworthy CPGs: Part II, Traversing the Process
  • INTRODUCTION
  • ESTABLISHING EVIDENCE FOUNDATIONS FOR AND RATING STRENGTH OF RECOMMENDATIONS
  • ARTICULATION OF RECOMMENDATIONS
  • EXTERNAL REVIEW
  • UPDATING
  • CONCLUSION
  • REFERENCES
• 6. Promoting Adoption of Clinical Practice Guidelines
  • INTRODUCTION
  • STRATEGIES FOR IMPLEMENTATION OF CPG RECOMMENDATIONS
  • DECISION ANALYTIC MODELING AND CPG IMPLEMENTATION
  • LEGAL ISSUES AFFECTING CPG IMPLEMENTATION
  • REFERENCES
• 7. Development, Identification, and Evaluation of Trustworthy Clinical Practice Guidelines
  • INTRODUCTION
  • WHO SHOULD DEVELOP GUIDELINES?
  • SHOULD THERE BE A PROCESS TO IDENTIFY CPGS THAT MEET THE PROPOSED TRUSTWORTHY STANDARDS?
  • IS THERE A CONTINUING NEED FOR A GUIDELINE CLEARINGHOUSE?
  • SHOULD THERE BE A PROCESS TO HARMONIZE RELATED CPGS?
  • SHOULD THERE BE A PROCESS TO IDENTIFY WHICH RECOMMENDATIONS SHOULD BE CONSIDERED FOR QUALITY MEASURES?
  • HOW SHOULD CPG DEVELOPMENT AND IMPLEMENTATION PROCESSES AND IMPACT BE EVALUATED?
  • REFERENCES
• Appendix A Abbreviations and Acronyms
• Appendix B Workshop Agenda and Questions to Panelists
• Appendix C Clinical Practice Guideline Appraisal Tools
• Appendix D Systems for Rating the Strength of Evidence and Clinical Recommendations
• Appendix E Literature Search Strategy: Clinical Practice Guidelines
• Appendix F Committee Biographies

This study was supported by Contract No. HHSP23320042509XI between the National Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Suggested citation:

IOM (Institute of Medicine). 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.