NQMC calls for clarity, transparency in clinical practice guidelines
To be effective, clinical practice guidelines must be clear and concise, and developers’ conflicts of interest must be disclosed to ensure trustworthiness, according to the National Quality Measures Clearinghouse/National Guideline Clearinghouse (NQMC/NGC) editorial board.
The board released its recommendations in a consensus viewpoint to periodically review "multiple dimensions of clinical practice guidelines (CPGs) and quality measures, using information from the thousands of measures and guidelines that the Clearinghouse staff has inventoried and summarized,” the authors wrote.
“Two current issues have prompted this statement. The first is the need to establish the ‘trustworthiness’ of a CPG. Making funding sources for the guideline and potential conflicts of interest more transparent can contribute to the trustworthiness of the guideline. Disclosure of this information helps inform decision making about the suitability of a guideline.
“The second issue, promoting actionable CPGs, is prompted by the [IT]-driven transition of CPGs from their publication in books and journals to their electronic availability online; now CPGs can be accessed throughout hospitals, within practices, or at the bedside, and they often are embedded in clinical decision support systems (CDSs). This last application, the transition to CDSs, requires CPG developers to formulate actionable and unambiguous recommendation statements."
The board made these recommendations for CPG developers:
The work was authored by board members Richard C. Hermann, MD, and Paul G. Shekelle, MD, PhD, co-chairs; Ethan Balk, MD; Jerod M. Loeb, PhD; Kathleen N. Lohr, PhD; Mark J. Monteforte, MD; Eric C. Schneider, MD; and Robert Wachter, MD.
The complete consensus viewpoint can be found here.
The board released its recommendations in a consensus viewpoint to periodically review "multiple dimensions of clinical practice guidelines (CPGs) and quality measures, using information from the thousands of measures and guidelines that the Clearinghouse staff has inventoried and summarized,” the authors wrote.
“Two current issues have prompted this statement. The first is the need to establish the ‘trustworthiness’ of a CPG. Making funding sources for the guideline and potential conflicts of interest more transparent can contribute to the trustworthiness of the guideline. Disclosure of this information helps inform decision making about the suitability of a guideline.
“The second issue, promoting actionable CPGs, is prompted by the [IT]-driven transition of CPGs from their publication in books and journals to their electronic availability online; now CPGs can be accessed throughout hospitals, within practices, or at the bedside, and they often are embedded in clinical decision support systems (CDSs). This last application, the transition to CDSs, requires CPG developers to formulate actionable and unambiguous recommendation statements."
The board made these recommendations for CPG developers:
- Describe conflict of interest policies to disclose potential conflicts of interest, and to describe all funding sources for the development of their CPGs. “Several different types of potential conflicts of interest can influence guideline development—including financial, professional and intellectual conflicts. … The board strongly urges CPG developers to disclose any potential conflicts of interest and to describe all funding sources for the development of their CPGs.”
- Formulate actionable, executable recommendation statements that employ active voice rather than passive voice. “Recommendations should be decidable (i.e., every condition should be described clearly enough so that reasonable practitioners can be expected to agree on the clinical circumstances under which the recommendation should be applied).” The recommended action—what to do, or perhaps what not to do—should be stated specifically and unambiguously.
- If a recommendation statement is not actionable, then the guideline should explicitly state why a recommendation cannot be made.
- Distinguish explicitly between factual statements and recommendations.
The work was authored by board members Richard C. Hermann, MD, and Paul G. Shekelle, MD, PhD, co-chairs; Ethan Balk, MD; Jerod M. Loeb, PhD; Kathleen N. Lohr, PhD; Mark J. Monteforte, MD; Eric C. Schneider, MD; and Robert Wachter, MD.
The complete consensus viewpoint can be found here.