The American College of Physicians (ACP) has established updated recommendations for developing clinical guidelines and guidance statements that address prevention, screening, diagnosis, and treatment of various diseases. These recommendations, published in the Annals of Internal Medicine, are based on scientific evidence derived from systematic literature reviews and expert consensus.
The ACP convened the Clinical Guidelines Committee (CGC), a multidisciplinary group including a nonphysician public panel, to put forth clinical policy papers in accordance with the Guidelines International Network and the National Academy of Medicine. The CGC’s enhanced methodology recommendations include more stringent disclosures of interests and management of conflicts, involving public perspective, use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method, and reporting formats that consider the value of care, patient comorbid conditions, patient preferences and values, and cost.
The CGC’s recommendations for disclosing interests and managing conflicts of interest emphasize full disclosure of all healthcare-related interests, including financial and intellectual interests from the past 3 years, by any persons involved in the development of clinical guidelines. In addition, the CGC panel recommends grading potential conflicts of interest as high, moderate, or low, and restricting members’ involvement accordingly.
Topic selection and guideline scope should consider the intervention’s prevalence, impact, and effect on morbidity and mortality (including on patient comorbid conditions). They should also include areas of clinical uncertainty and the availability of effective healthcare alternatives. The ACP guidelines should further discuss implications of cost and resources. Guidance statements should ensure that guidelines produced by other organizations are also available.
Whereas CGC expert and public panels are required to independently rate outcomes in evidence reviews, the updated CGC methodology recommends the full adoption of criteria put forth by the GRADE framework. GRADE is also used to determine the quality of evidence and the strength of recommendations. Final recommendations should rigorously consider an intervention’s benefits and harms, patient preferences and value (making sure to incorporate the public perspective), and costs and burden of care.
Qaseem A, Kansagara D, Lin JS, Mustafa RA, Wilt TJ. The development of clinical guidelines and guidance statements by the clinical guidelines committee of the American College of Physicians: update of methods [published online June 11, 2019]. Ann Intern Med. doi:10.7326/M18-3290