Guidance for Guidelines

Steinbrook, Robert

doi:10.1056/nejmp068282

Cited by 122 publications

(120 citation statements)

References 4 publications

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“…The reasons offered are diverse, and include behavioral and operational barriers to include decreased awareness, adoption, adherence, buy-in and supportive organizational culture. [20][21][22][23][24][25][26] Even with awareness, providers will often use clinical judgment at the point of patient care rather than researchbased recommendations. 25 The SCAMPs approach to quality improvement largely avoids these shortcomings.…”

Section: Discussionmentioning

confidence: 99%

Regional Implementation of a Pediatric Cardiology Chest Pain Guideline Using SCAMPs Methodology

et al. 2013

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BACKGROUND AND OBJECTIVES: Chest pain is a complaint for which children are frequently evaluated. Cardiac causes are rarely found despite expenditure of considerable time and resources. We describe validation throughout New England of a clinical guideline for cost-effective evaluation of pediatric patients first seen by a cardiologist for chest pain using a unique methodology termed the Standardized Clinical Assessment and Management Plans (SCAMPs). METHODS: A total of 1016 ambulatory patients, ages 7 to 21 years initially seen for chest pain at Boston Children’s Hospital (BCH) or the New England Congenital Cardiology Association (NECCA) practices, were evaluated by using a SCAMPs chest pain guideline. Findings were analyzed for diagnostic elements, patterns of care, and compliance with the guideline. Results from the NECCA practices were compared with those of Boston Children’s Hospital, a regional core academic center. RESULTS: Two patients had chest pain due to a cardiac etiology, 1 with pericarditis and 1 with an anomalous coronary artery origin. Testing performed outside of guideline recommendations demonstrated only incidental findings. Patients returning for persistent symptoms did not have cardiac disease. The pattern of care for the NECCA practices and BCH differed minimally. CONCLUSIONS: By using SCAMPs methodology, we have demonstrated that chest pain in children is rarely caused by heart disease and can be evaluated in the ambulatory setting efficiently and effectively using minimal resources. The methodology can be implemented regionally across a wide range of clinical practice settings and its approach can overcome a number of barriers that often limit clinical practice guideline implementation.

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Section: Discussionmentioning

confidence: 99%

Regional Implementation of a Pediatric Cardiology Chest Pain Guideline Using SCAMPs Methodology

et al. 2013

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“…Therefore, some organisations have gone further and exclude authors with a COI from relevant decision making [48]. Guyatt and colleagues [38,49] suggest that methodologists without any COI should lead guideline development and have the primary responsibility.…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…Although the IOM standards have recently been criticised because they do not address the accessibility of COI policies and the optimal presentation of disclosures [48], they go far beyond the minimal standards defined by G-I-N [3]. The latter do not precisely define a management of COI policy; the focus is on disclosure of financial and nonfinancial COIs rather than on the procedures of disclosure, the COI threshold in a CPG, the role of funders and absence of COIs for chairs of the CPG.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Evidence base in guideline generation in diabetes

Mühlhauser¹,

Meyer

2013

Diabetologia

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During recent years much emphasis has been on the validity, reliability, reproducibility, clinical applicability, clarity, multidisciplinary process, scheduled review and documentation of clinical practice guidelines (CPGs). Still, CPGs show substantial variance in methodological quality. The present paper mainly focuses on two aspects that are particularly critical and contemporary from the perspective of evidence-based medicine: patient centredness and shared decision making, and conflict of interest. Sophisticated patient and consumer involvement at all stages of CPG development could be judged as being the gold standard. However, co-opting patients or consumer representatives and using other techniques of active patient involvement does not replace individual patient preferences in clinical decision-making processes. Current CPGs do not meet patient needs, since they do not provide concise, easy-to-read summaries of the benefits and risks of medicines together with more comprehensive scientific data as a prerequisite for informed or shared decision making. The vast majority of CPG panels have a financial conflict of interest (COI) and under-reporting is common. Not all organisations producing CPGs have set up COI policies, and existing policies vary widely. To solve the problem, CPG experts have recommended that methodologists without any important COI should lead the development process and have primary responsibility. There is a lot of room for other improvements through network transnational activities in the field of CPG development. Waste of time and resources should be avoided through sharing published and unpublished data identified, appraised and extracted for guideline development. The EASD could provide such a clearing house.

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“…20 Others have suggested that guidelines will be most trusted only when individuals with conflicts of interest are excluded entirely. 21 Policies to address conflicts of interest should also be developed for individuals involved in other areas of the drug evaluation system. For example, all support from pharmaceutical companies or governments to patient advocacy groups should be publicly reported.…”

mentioning

confidence: 99%