June 1, 2009 The world's largest ear, nose, and throat professional medical association, the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS), today released a manual detailing best practices for the creation of new clinical practice guidelines. The manual is published as a supplement to the June issue of Otolaryngology – Head and Neck Surgery.
Clinical practice guidelines are created to help direct decisions and criteria regarding diagnosis, management, and treatment in medical practice. They seek to identify, summarize, and evaluate the best evidence and most current data about prevention, diagnosis, prognosis, therapy (medication/procedures), risk vs. benefit profile, and cost-effectiveness.
"Clinical practice guidelines translate best evidence into best practice. A well-crafted guideline promotes quality by reducing healthcare variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective— or potentially harmful—interventions," said Richard M. Rosenfeld, MD, MPH, co-author of the guideline. "Despite a plethora of published guidelines, methodology is often poorly defined and varies greatly within and among organizations."
According to the authors, published guidelines are often poorly suited to assess performance or influence care, because recommendations do not translate into measurable actions or activities. Moreover, the development process is generally inefficient and highly complex, requiring, on average, about two to three years per guideline. Using the process outlined in the new manual, the AAO-HNS was able to publish five multidisciplinary guidelines in five years, all within 12 months from conception to completion.
The goals of publishing the manual were, first, to provide clinicians with a straightforward explanation of guidelines, considering their increasing prominence as a quality metric. Secondly, the manual is intended to be a pragmatic resource, accurately reflecting current practices, in order to sustain consistency across guideline development practices. Finally, the manual seeks to share the AAO-HNS' successful development process with the medical community at large, to encourage an exchange of ideas and to promote best practices.
"Our goal was to create an approach to guideline development that is both practical and transparent. Guideline users increasingly recognize that understanding the evidence supporting a recommendation is vital, but that authoring teams must additionally weigh and document anticipated benefits, risks, harms, and costs," said Richard N. Shiffman, MD, MCIS, co-author of the manual.
The manual breaks down the development process and gives in-depth instructions for guideline task force administrators. The steps include planning, literature review, assigning the writing, peer review, organizational board review, and publication.
As clinical practice guidelines become more prominent as key metrics of quality healthcare, organizations must develop efficient production strategies that balance rigor and pragmatism. Equally important, clinicians must become savvy in understanding what guidelines are—and are not—and how they are best utilized to improve care. The information in this manual should help clinicians and organizations achieve these goals, and improve patient care.
Otolaryngology – Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) and the American Academy of Otolaryngic Allergy (AAOA). The manual's authors are Richard M. Rosenfeld, MD, MPH from SUNY Downstate and the Long Island College Hospital and Richard N. Shiffman MD, MCIS from the Yale Center for Medical Informatics and Yale University School of Medicine.
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