Today, the task force is simply called the Guidelines Task Force (GTF). Since its inception, it has published 13 clinical practice guidelines, including guidelines for allergic rhinitis, Bell’s palsy, and tympanostomy tubes in children. Five more guidelines, including those for Meniere’s disease and epistaxis, are currently in development, and at least six more (including one on age-related hearing loss) are in the development queue. The American Academy of Otolaryngology–Head and Neck Surgery Foundation also recently released a clinical consensus statement on balloon dilation of the sinuses.
Explore This IssueMay 2018
Consensus Statements vs. Clinical Practice Guidelines
The phrase “clinical guidelines” is often used as a catch-all to describe any official document that offers guidance on practice, but there are important differences between consensus statements and clinical practice guidelines.
“What differentiates a consensus statement from a clinical practice guideline is that a clinical practice guideline requires the evidence to be robust. If you’re actually going to come out and say, ‘This is what should be done,’ you need to have high-level evidence,” said Richard Orlandi, MD, an otolaryngologist and professor of surgery at the University of Utah who worked on the 2016 International Consensus Statement on Allergy and Rhinology: Rhinosinusitis.
Clinical practice guidelines are also developed with input from multiple medical specialties and consumers. A committee working to develop a clinical practice guideline on rhinosinusitis, for instance, would include not only representatives of the American Rhinologic Society and the American Academy of Otolaryngology–Head and Neck Surgery, but also allergists, immunologists, infectious disease specialists, and patient advocates.
“It’s critical to have the right people there,” Dr. Rosenfeld said. “What we do is reach out to the leadership of any stakeholder group we feel is important and ask the leadership, ‘Who do you feel can advocate for you appropriately so your input is duly considered?’”
Consumer representatives typically come from advocacy groups such as the American Tinnitus Association or Consumers United for Evidence-Based Healthcare, a national coalition of health and consumer advocacy organizations.
The Effect of Guidelines on Practice and Reimbursement
Many insurers and third-party payers, including CMS, consider clinical guidelines when determining the medical necessity of a given treatment; medical care that aligns with published guidelines is likely to be covered and reimbursed.
Because clinical guidelines are based on the best available evidence, they can “temper the over-utilization of resources,” Dr. Schofield said, noting that CTs and MRIs, for instance, were often ordered simply to ensure that nothing was overlooked when working up certain problems. Guidelines that say, Imaging is not recommended unless x, y or z, can support a physician’s decision to order—or not order—the test.