Systematic Reviews and American College of Physicians Clinical Practice Guidelines

Slide Presentation from the AHRQ 2011 Annual Conference

Slide 1

Systematic Reviews and American College of Physicians Clinical Practice Guidelines

Amir Qaseem, MD, PhD, MHA, FACP
Director, Clinical Policy
American College of Physicians (ACP)

Slide 2

Who We Are

• Largest medical specialty organization in the U.S.
• 132,000 members:
  • Internists.
  • Internal Medicine sub-specialists.
  • Residents/fellows training in Internal Medicine or its subspecialties.
  • Medical students.
• Headquarters in Philadelphia and an office in Washington, D.C.

Slide 3

History of ACP Clinical Guidelines

• Program was established in 1981.
• Developed by Clinical Guidelines Committee.
• Screening, Dx, and Rx to help clinicians in making health care decisions.

Slide 4

Slide 4. Education

ACP's Guidelines Coverage

• Top 3 most valued product.
• Most common reason to visit ACP's Web site.
• 25 of the top 100 most read articles ever in the Annals of Internal Medicine.
• Top most read article in Internal Medicine on Medscape.
• All ACP Guidelines are regularly covered by print, TV, radio, and online stories.

Slide 5

ACP Guidelines Coverage

Slide 6

ACP and Systematic Reviews

• Clinical Policies:
  • Clinical Guidelines.
  • Guidance Statements.
  • High-Value Cost Conscious Care Advice.
• Performance measurement.
• Gaps.

Slide 7

ACP Membership Feedback

• High quality guidelines.
• Based on scientific evidence.
• Helpful source of advice.
• Not rigid or difficult to apply.
• Not difficult to understand or use.

Slide 8

The Need for a Good Systematic Review?

• Medical literature is expanding at an extremely fast rate.
• RCTs in MEDLINE (5,000 per yr from 1978-1985 to 25,000 per year in 1994-2001).
• 15 million citations on MEDLINE and 10,000-20,000 added per week.
• Evidence → Clinical Guidelines.

Slide 9

ACP and Systematic Reviews

• Systematic Reviews:
  • ACP sponsored.
  • Collaboration with other societies.
  • AHRQ's Evidence-based Practice Centers:
    • Working together since1999.
    • EPC & EHC.
    • 66% of our guidelines based on EPC evidence reports.
• Available Systematic Reviews.

Slide 10

Issues with Systematic Reviews

• Major variation in quality.
• COI.
• Multidisciplinary.
• Scope not clearly defined or followed.
• Key Questions not well-formulated.

Slide 11

Issues with Systematic Reviews

• Poor methods or poorly documented methods.
• Lack of a standard reporting system.
• Lack of a grading system.
• Do not address all outcomes.

Slide 12

Relationship between Guideline Developers & Systematic Review Developers

• What is the purpose of a Systematic Review (SR)?
• Balance inappropriate influence with critical input.
• Develop a line of communication with guideline group.
• Include a rep in TEP [Technical Expert Panel].
• Responsiveness to the questions of guideline group.

Slide 13

Relationship between Guideline Developers & Systematic Review Developers

• Registry of systematic reviews:
  • GINDER (Guidelines International Network).
  • PROSPERO (National Institute for Health Research).

Slide 14

Clinical Practice Guidelines

• "Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options."

Slide 15

Summary

• SR are the backbone of a guideline.
• A good and well-developed SR is costly, resource intensive, and time consuming.
• Some of us underestimate the resources and expertise needed and the result is variability in quality of SRs.
• A good SR is a collaborative effort and guideline developers should be able to provide their expertise among the contributors.

Slide 16

Questions
 

Current as of December 2011

Internet Citation:

Systematic Reviews and American College of Physicians Clinical Practice Guidelines. Slide Presentation from the AHRQ 2011 Annual Conference (Text Version). December 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualconf11/bar-cohen_childs_qaseem/qaseem.htm