Methodology for the American Society of Hematology VTE guidelines: current best practice, innovations, and experiences

Abstract

Background: Methods for the development of clinical guidelines have advanced dramatically over the past 2 decades to strive for trustworthiness, transparency, user-friendliness, and rigor. The American Society of Hematology (ASH) guidelines on venous thromboembolism (VTE) have followed these advances, together with application of methodological innovations. Objective: In this article, we describe methods and methodological innovations as a model to inform future guideline enterprises by ASH and others to achieve guideline standards. Methodological innovations introduced in the development of the guidelines aim to address current challenges in guideline development. Methods: We followed ASH policy for guideline development, which is based on the Guideline International Network (GIN)-McMaster Guideline Development Checklist and current best practices. Central coordination, specialist working groups, and expert panels were established for the development of 10 VTE guidelines. Methodological guidance resources were developed to guide the process across guidelines panels. A methods advisory group guided the development and implementation of methodological innovations to address emerging challenges and needs. Results: The complete set of VTE guidelines will include >250 recommendations. Methodological innovations include the use of health-outcome descriptors, online voting with guideline development software, modeling of pathways for diagnostic questions, application of expert evidence, and a template manuscript for publication of ASH guidelines. These methods advance guideline development standards and have already informed other ASH guideline projects. Conclusions: The development of the ASH VTE guidelines followed rigorous methods and introduced methodological innovations during guideline development, striving for the highest possible level of trustworthiness, transparency, user-friendliness, and rigor.

American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

“…During the first phase, we used methodology for guideline development consistent with the ASH guidelines for management of VTE, but with a condensed timeline. 47 This was a rapid guideline-development process, with systematic review searches being conducted on 19 July and 19 August 2020, followed by the drafting of recommendations on 29 September 2020. Panel and Methods team members also suggested additional important eligible studies until 29 September 2020.…”

“…The panel selected outcomes of interest for each prioritized question a priori, following the approach described in detail elsewhere. 47 In brief, we used the outcomes that the ASH management of VTE guideline panels prioritized as our initial candidate outcomes using health outcome descriptors ( https://ms.gradepro.org ). 39 , 58 , 59 , 60 , 61 , 62 , 63 , 64 We then asked for additional outcomes that may be important or critical for decision-making in COVID-19–related illness.…”

A user guide to the American Society of Hematology clinical practice guidelines

“…ASH guideline panels prioritize questions using a variety of techniques, including discussion, surveys, and voting. 47 For every prioritized question, the panel also prioritizes clinical outcomes that are critical or important for decision-making. 47,48 The prioritized questions, including outcomes, are reported in the guidelines and the EtD frameworks.…”

“…47 For every prioritized question, the panel also prioritizes clinical outcomes that are critical or important for decision-making. 47,48 The prioritized questions, including outcomes, are reported in the guidelines and the EtD frameworks. Some ASH guidelines also include as supplemental files the results of any prioritization surveys.…”

Postpartum care indications and methodological quality:a systematic review of guidelines

“…The practice guidelines are of the highest quality of evidence level according to the 6S hierarchy of evidence pyramid (Dicenso et al 2009 ). Although evidence-based guidelines are being developed to bridge the gap between research and routine practice, with the goals of changing and improving health care quality (Flodgren et al 2016 ), they are inconsistent in application (Campbell et al 2006 ; Wiercioch et al 2020 ). In recent years, postpartum care guidelines have been issued in many international and national organizations, which aimed to provide evidence-based recommendations for the management of postpartum women and their newborns health.…”