next steps: implementation workshop on standards for systematic reviews and clinical practice...
TRANSCRIPT
Next Steps: Implementation Workshop on Standards for
Systematic Reviews and Clinical Practice Guidelines
Next Steps: Implementation Workshop on Standards for
Systematic Reviews and Clinical Practice Guidelines
Institute of MedicineInstitute of Medicine
Sandra Zelman Lewis, PhD
American College of Chest PhysiciansAmerican College of Chest Physicians
Sandra Zelman Lewis, PhD
American College of Chest PhysiciansAmerican College of Chest Physicians
May 10-11, 2010May 10-11, 2010
Role and RelevanceRole and RelevanceRole and RelevanceRole and Relevance
Oversee development and implementation of ACCP evidence-based clinical practice guidelines and consensus statements
Evidence-based derivative products
Implementation efforts
Develop and guide methodology
Education in EBM methodology
Impact of the IOM ReportsImpact of the IOM Reports
ACCP is pleased with the IOM reports o They raise the baro They define trustworthiness of
EB guidelines• But would have liked to reserve the title “Guidelines”
for trustworthy guidelines
ACCP meets nearly all of the IOM standards for trustworthy guidelineso A few met in part but can fairly readily achieve full
compliance• Intellectual COIs (currently only one guideline)
Aim to meet nearly all IOM standards
ImpactImpact But there is one IOM standard we will never meet:
o Cannot post content ahead of publication for public comments
o Violation of the embargo
And one standard we are not likely to meet very soon -Patient or public involvemento Discouraging experience with
aggressive patient advocacy groupo Decision made to use instead:
Ethicists Professionals in patient
values/preferences EBM-trained consumers
Strategies Strategies Maintaining currency:
Annual reviews Living guidelines model
Articulation of recommendations Describe patient population first Strong: “We recommend” and Weak: “We suggest”
External reviews and harmonization Invited related associations/organizations
• Invited panelists/representatives• Reviews for endorsements (NDAs)
Reviewing and managing conflicts of interest Rigorous reviews and high standards Financial and intellectual Methodologists as chapter editors in key areas
• health economists, frontline clinicians COI grid – applicable to individual
recommendations
Conflict of InterestConflict of InterestConflict of InterestConflict of Interest
Example of COI GridExample of COI Grid
Recommendation
Chapter Editor Deputy Editor Co-author 1 Co-author 2 Co-author 3 Co-author 4
type description type description type description type description type description type description
Rec 1
Rec 2 2ry Gdln Author
Rec 3 2ry PI 2ry Gdln Author
Rec 4 1ry Consult 1ry Speaker
Rec 5 1ry Advisory 1ry
Rec 6 2ry PI
Standards ACCP MeetsStandards ACCP Meets
identify strategies for implementing the standards. Some topics you may want to address in your presentations include: examples of how your organization is implementing the standards, lessons learned from implementation efforts, strategies for overcoming barriers to implementation, suggestions on the types of resources and support you will need to implement the standards (beyond additional funding), and potential areas for collaboration in conducting systematic reviews and guidelines