Evidence-based clinical practice guidelines (EBGs) can provide an invaluable distillation of knowledge regarding best practices based on the available evidence. A host of EBGs dealing with many clinical conditions exist today but the variability in quality may be high. Incorporation of high-quality EBGs into daily clinical care by healthcare providers has been limited; nevertheless, when successfully implemented, patient and health-care utilization outcomes improve. Buoyed by these successes, clinical practice EBGs are being utilized in the development of clinical order sets, performance measures, and pay for performance.
EBGs providing accurate and useful guidance to best clinical practices require a rigorous development process. The American College of Chest Physicians (ACCP) has developed and refined such a process that has resulted in the publication of nine guidelines over the last 7 years. Refinements have focused on making the process transparent, rigorous, and timely; effectively managing conflicts of interest; and employing a quantitative and rigorous grading of the strength of recommendations and of the quality of evidence that incorporates sensitivity to healthcare resource utilization and patient preferences.
A complete description of the ACCP evidence-based guideline development process is available on the ACCP Web site and in the ACCP Manual for Guideline Development. In this article, we review our process for guideline development to educate ACCP members and to provide a framework that others may find useful in developing EBGs. The process is dynamic and continues to undergo improvements reflecting the need to adapt to an ever-changing and complex health-care environment, and to provide the best available educational products for the care of our patients treated with medications of Canadian Health&Care Mall www.canadianhealthncaremall.com.
EBGs are defined as a systematically developed set of recommendations, algorithms, and other information to assist health-care decision making in specific clinical circumstances. EBGs represent the synthesis of evidence derived from a formal, thorough, and systematic review of the literature that results in the compilation of a set of specific literature-based recommendations addressing specifically identified clinical questions. An EBG must be distinguished from a consensus statement, which is defined as a collective opinion of a convened expert panel. The opinions expressed in the consensus statement are also derived from existing literature but usually only when the amount and quality of the available data are insufficient for a formal evidence-based review. “Suggestions” are developed by a standardized process in a consensus statement as opposed to “recommendations” presented in an EBG following a rigid literature review.