Systematic Reviews: Evidence to Advance Decision Making

Nancy O’Reilly, MHS, PMPSenior Director, Gynecologic Practice and WPSI

American College of Obstetricians and Gynecologists November 1, 2018

• First Practice Bulletin published in 1998

• 200 titles published since inception

• Current Practice Bulletins ◦ 45 Obstetric ◦ 35 Gynecology

• Methodology summary listed on published document

• Posted on ACOG website

• Process undergoing update, so new process will be published and posted on website

• Authors and Chairs required to have no related financial conflicts

• Members with potential conflicts have restrictions on input and voting

• Conflicts for members and authors updated, evaluated and disclosed to committee throughout process

• No external funding supports guideline development work

• Standing committees 1) Gynecology and 2) Obstetrics

• 8-10 Ob-Gyn members with methodologic expertise

• 2 public members

• Collaboration in document development ◦ Ob-Gyn subspeciality

organizatons ◦ Other Medical Specialty

Societies

•Evidence Review ◦ In-house medical librarians ◦ MEDLINE database, Cochrane Library, Guidelines from

other organizations or institutions ◦ Based on PICO elements identified in outline

•Organized by level of evidence: o Systematic Reviews* o Randomized Controlled Trials o Observational Studies o Organizational Guidelines

• Based on previous USPSTF methodology

• Evidence identified based on inclusion/ exclusion criteria

• Recommendations directly linked to evidence

• Evidence maps to review supporting evidence quality and confirm recommendation

• Recommendations: ◦ Level A – good, consistent ◦ Level B – limited or inconsistent ◦ Level C – expert opinion

• Clinical Document Review Panel ◦ Content review ◦ Ob Panel and Gyn

Panel ◦ 8 members each ◦ Previous Practice

committee membership ◦ Written response to

comments

• Executive Board ◦ Review by full

Executive Board ◦ Board leadership,

representatives from12 ACOG Districts; partner organizations ◦ Primarily policy

review

• Published in Obstetrics and Gynecology • Full guideline reviewed every 18-24 months

at in-person meeting • Horizon scan for new evidence on-going for

each topic • Updated when new clinical data would

prompt change to recommendation(s)

• Engaged with AHRQ EPCs since 1998◦ Nomination of topics ◦ Participation in Technical Expert Panels ◦ Expert review of final reports

• Partner with several EPCs including:◦ Duke ◦ UNC/RTI ◦ Vanderbilt ◦ OHSU

• Review EPC reports as partner organization toUSPSTF

• Collaboration with EPCs allows identification and evaluation of most important clinical issues

• Clinical experts/authors involved at each stage of S/R development

• Input at PICO development stage • Prioritized as highest level of evidence to develop

accurate recommendations • Serves as the anchor to our clinical practice

guidelines

• Over 20 Practice Bulletin titles based on EPC Systematic Reviews

• Practice Bulletin #137 Gestational Diabetes Mellitus (2013) • Practice Bulletin # 131 –Screening for Cervical Cancer (2013) • Practice Bulletin #129 – Osteoporosis (2012) • Practice Bulletin #107 Induction of Labor (2009) • Practice Bulletin #105 – Bariatric Surgery and Pregnancy

(2009) • Practice Bulletin #96 – Alternatives to Hysterectomy in

Management of Leiomyomas (2008)

►Additional topics in process

• Committee Opinions • CO 561 -Nonmedically Indicated Early-Term Deliveries (2013) • CO 559 - Cesarean Delivery on Maternal Request (2013) • CO 372 - The Role of Cystourethroscopy in the Generalist

Obstetrician-Gynecologist Practice (2007)

• Books and special projects • Hypertension in Pregnancy Task Force Report (2013) • Induction of Labor - Patient Safety Checklist (2011) • Neonatal Encephalopathy and Cerebral Palsy-Defining the

Pathogenesis and Pathophysiology (2003)