Transcript Document
American College of Chest Physicians (ACCP) Health and Science Policy Committee
Orientation Program
Part #3 Development of Evidenced-based Practice Guidelines
Development of an Evidence-Based Guideline
Submission of guideline topic • Serves as a comprehensive tool for topic evaluation • Components of the application: Background information and rational for development of the guideline Current available data and number of high quality studies Potential funding partnerships Potential dissemination and implementation tools • Guideline topics can be submitted from NetWorks, general ACCP membership and/or the public at large • Applications must be submitted by December 31 of the calendar year and will be considered at the spring HSP face-to-face meeting
Development of an Evidence-Based Guideline
Review and approval of proposed topic by HSP Committee • Approval is based on the following criteria: 1.
Conditions in which the diagnosis and management of the disease could be significantly improved by a change in practice 2. A body of published evidence exists on which to base the guideline 3. The topic has a wide variability in practice 4. The topic reflects the constituency of the College and crosses over various disciplines of the College 5. The topic is controversial 6. The topic includes interventions that potentially have high economic cost 7. The topic is of interest and importance to public health
Development of an Evidence-Based Guideline
Review and approval of proposed topic by HSP Committee • If a proposed topic is not accepted for development it will be: Submitted back to the NetWork for possible development of a NetWork project Considered for possible development at a later date
Development of an Evidence-Based Guideline
Accepted for evidence-based guideline development • Examine and determine available funding possibilities Develop a budget • Based on funding consider a source for evidence review: Send a proposal to the Agency for Healthcare Quality and Research (AHRQ) for funded evidence review Send out Request for Proposal’s (RFPs) to Evidence Centers for contractual evidence review Conduct an in-house evidence review • Send proposal to the BOR for approval • Inform
CHEST
Editor-in-Chief of topic
Development of an Evidence-Based Guideline
Panel is nominated and approved • The Executive Committee is nominated and approved by the HSP Committee and consists of: Chair or Co-Chairs The methodologist The project coordinator • The Executive Committee is charged with keeping the project on track and promoting communication and oversight.
Development of an Evidence-Based Guideline
Panel is nominated and approved
Selection of Chair or Co-Chairs
• The panel chair(s) is chosen for his or her: Reputation as a clinician and/or scientist in the topic area Ability to organize and work well with a group Track record of delivering quality products in a timely fashion
Development of an Evidence-Based Guideline
Panel is nominated and approved
Responsibilities of the Chair or Co-Chairs
• Coordination and communication with staff and methodologist • Development a proposed scope and outline of the project discussion at the first panel meeting • Supervision of responsibilities of panel members • Review and edit reports for scientific content and completeness • Participation in activities related to the dissemination of the report • Set an example and encourage the panel to follow the processes and regulations for guideline development
Development of an Evidence-Based Guideline
Panel is nominated and approved
Selection of Panel Members
• The panel members are selected with regard to: Clinical and/or scientific expertise Writing skills Ability to work well on a team Diversity in geographic location Gender ACCP membership
Development of an Evidence-Based Guideline
Panel is nominated and approved
Selection of Panel Members
• Nominations for panel member positions are sought from: NetWorks HSP Committee Panel Chair(s) Other panelists • The HSP Committee must approve all nominations.
• One HSP Committee member shall serve as the HSP liaison • At least one panel member should have experience in evidence –based medicine and methodology.
Development of an Evidence-Based Guideline
Panel is nominated and approved
Role of the HSP Liaison
• One member from the HSP Committee will be appointed as a liaison to the guideline panel with the responsibility of: Representing the HSP Committee Working with the ACCP staff to identify the chair and potential guideline panel members Communicating the progress of the panel and any procedural questions regarding the panel and the guideline to the Guidelines Subcommittee and HSP Committee Reviewing of draft documents as appropriate prior to the conference and during HSP review and approval Attending panel meetings as needed
Development of an Evidence-Based Guideline
Panel is nominated and approved
Termination of Panel Members
Panel members may be terminated for reasons including, but not limited to the following: • Failure to disclose conflicts of interest Inability to resolve a disclosed conflict of interest • Nonparticipation • Failure to complete assignments in a timely fashion • Inability to work as a team member
Development of an Evidence-Based Guideline
Scope of Topic is narrowed and research questions are defined The research questions should include: • The patient population • The control group • The exposure or interventions • Outcomes • Clarification of the inclusion criteria
Development of an Evidence-Based Guideline
Scope of Topic is narrowed and research questions are defined
P
atient Population
PICO Table I
ntervention or Exposure
C
ontrol Group or comparison Intervention
O
utcome(s)
Tips*
Start by describing a group of similar patients.
Balance precision with brevity.
Ask,
“Which main intervention should be considered?”
Be specific.
Ask,
“Which is the main alternative to compare with the intervention?”
Be specific.
Ask,
“Which can be accomplished?” or “What could this exposure/intervention really affect?”
Be specific.
Example
“ In patients with heart failure from dilated cardiomyopath “…would adding anticoagulation with warfarin to standard heart failure therapy…” “…when compared with standard therapy alone…” “…lead to lower mortality or morbidity from thromboembolism. Is this enough to be y who are in sinus rhythm…” worth the increased risk of bleeding?” *Centre for Evidence-Based Medicine, University Department of Psychiatry, Wameford Hospital, Headington, Oxford, OX3 7JX
Development of an Evidence-Based Guideline
Evidence reports developed • Evidence reports include a comprehensive examination of the scientific literature and appropriate analyses and a summary of the methodology used • Evidence reports are extensively reviewed by guideline panels • Evidence tables are produced as part of the evidence report and incorporate the results for each study that meets the predefined inclusion criteria
Development of an Evidence-Based Guideline
Evidence reports developed
Evidence Tables
• Minimize bias • Based on a rigorous process to identify the relevant literature • Provide scientific, rather than subjective, summaries of the literature • Reveal patterns and trends across multiple studies • Manage the volume of literature • Provide reliable evidence to aid clinical decision-making
Development of an Evidence-Based Guideline
Evidence reviewed • Once the literature review is completed and evidence reports are finalized the methodologist and writing committees should discuss the tables and articles to be certain that all relevant studies are included.
• Each author or writing committee engages in a complex and comprehensive process to interpret the data and derive guideline recommendations.
Development of an Evidence-Based Guideline
Guideline writing commences
II. Participants List III. Financial Disclosure and Sponsor Funding:
Disclosures of any financial support or author involvement with organization(s) with financial interest in the subject matter
III. Abstract
•Goals/Objectives •Methodology •Results •Conclusions
Development of an Evidence-Based Guideline
Guideline writing commences
IV. Key Words V. Abbreviations VI. The Introduction
• Provides a historical background of the topic • Incidence and prevalence rates • Overall justification of the importance of the topic and why it was chosen •Key recommendations or novel contributions of the guideline
Development of an Evidence-Based Guideline
Guideline writing commences
VII. Methodology
• How the panel was chosen • How the scope of the topic was refined • How the clinical questions were constructed • The inclusion and exclusion criteria • Criteria for eligible articles • How the recommendations were graded and the strength of the evidence
Development of an Evidence-Based Guideline
Guideline writing commences
VIII. The Discussion/Results/Recommendations IX. Future Research X. Conclusion XI. Summary of Recommendations XII. References XIII. Tables/Figures/Illustrations/Photos XIV. Appendices/Evidence Tables