Standardized Reporting of Clinical Practice Guidelines: A Proposal from the Conference on Guideline Standardization

Abstract

Despite enormous energies invested in authoring clinical practice guidelines, the quality of individual guidelines varies considerably. The Conference on Guideline Standardization (COGS) was convened in April 2002 to define a standard for guideline reporting that would promote guideline quality and facilitate implementation. Twenty-three people with expertise and experience in guideline development, dissemination, and implementation participated. A list of candidate guideline components was assembled from the Institute of Medicine Provisional Instrument for Assessing Clinical Guidelines, the National Guideline Clearinghouse, the Guideline Elements Model, and other published guideline models. In a 2-stage modified Delphi process, panelists first rated their agreement with the statement that "[Item name] is a necessary component of practice guidelines" on a 9-point scale. An individualized report was prepared for each panelist; the report summarized the panelist's rating for each item and the median and dispersion of rankings of all the panelists. In a second round, panelists separately rated necessity for validity and necessity for practical application. Items achieving a median rank of 7 or higher on either scale, with low disagreement index, were retained as necessary guideline components. Representatives of 22 organizations active in guideline development reviewed the proposed items and commented favorably. Closely related items were consolidated into 18 topics to create the COGS checklist. This checklist provides a framework to support more comprehensive documentation of practice guidelines. Most organizations that are active in guideline development found the component items to be comprehensive and to fit within their existing development methods.

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

“…In selected cases references not identified by the 'literature group' were included in the evidence base, i. e., when authors found relevant articles published after 2008 during the period up to October 2010 when the chapter manuscripts were drafted and revised prior to publication. The methodological quality of the retrieved publications was assessed using the criteria obtained from published and validated checklists [30][31][32][33][34][35]. Preliminary versions of the draft guidelines were repeatedly reviewed and revised through multidisciplinary meetings attended by the authors, editors and the 'literature group', as well as in pan-European network meetings with participants from all of the 27 EU Member States.…”

Rigorous Development does not Ensure that Guidelines are Acceptable to a Panel of Knowledgeable Providers

“…However, given our findings, the mere performance of an external review appears insufficient to ensure clinical acceptability. Specific goals and methods for performing clinical reviews have not been established yet, 11,14,37 and they appear to be needed.…”

“…13,22 Existing evaluation methods address the structure and process of guideline development and assume-erroneouslythat favorable outcomes will result. 10,11,14 For example, having a well-defined scope and purpose should produce recommendations that providers find applicable to common clinical situations. Yet our panelists felt that none of the guidelines comprehensively covered one of the most common treatments *Excludes topics that were judged not comprehensive on the assumption that the guideline was not intended to cover those topics.…”

“…6 In part to increase the likelihood that providers will view guidelines favorably, 9 experts have established formal development and evaluation standards, the most widely accepted of which is the "Appraisal of Guidelines Research and Evaluation" Instrument (AGREE). [10][11][12][13][14] National Guidelines Clearinghouse requires basic standards. 15 Nevertheless, empirical research has not examined whether rigorous developmenti.e., good technical quality-consistently produces guidelines that providers find acceptable.…”

Atypical antipsychotic medication poisoning: An evidence-based consensus guideline for out-of-hospital management

“…The methods used for the preparation of this guideline were developed after reviewing the key elements of practice guidelines (10,11). An expert consensus panel was established to develop the guideline (Appendix 1).…”