Clinical Guidelines 101

• Transparency;
• Managing conflict of interest;
• Composition of the group developing the guidelines;
• Intersection of clinical practice guidelines and systematic review;
• Establishing evidence foundations for and rating strength of recommendations;
• Articulation of recommendations;
• External review; and Updating.

The IOM is urging the AHRQ to pilot-test these standards to assess their reliability and validity.

Further effort at ensuring the quality of clinical guidelines comes from the Guidelines International Network (G-I-N), a network of guideline developers from 46 countries that currently contains more than 3,600 clinical guidelines. In 2012, G-I-N proposed key components for guideline development aimed at establishing an international standard for guideline development (Ann Intern Med. 2012;156(7):525-531) (See Table 2, at left).

Misperceptions of Clinical Guidelines

The main aim of clinical guidelines is to improve the quality of patient care by providing physicians and other health care professionals with the best evidence on which to base clinical decision making. The goal is not to replace the judgment and experience of clinicians but to augment those critical tools with the most up-to-date, vetted and evaluated evidence. They should not be considered cookbook medicine. “Guidelines simply represent the best judgment of a team of experienced clinicians and methodologies addressing the scientific evidence on a particular topic,” said Rosenfeld and Shiffman.

Status of Guidelines: AAO-HNS

Currently, the AAO-HNS has published eight clinical guidelines. Given the intensive labor and high cost involved, the academy has published only one or two guidelines per year since 2006. According to Robert Stachler, MD, chair of the panel that developed the most recent AAO-HNS guideline on sudden hearing loss, these guidelines are models that other medical societies refer to when developing their own guidelines.